Breast lump removal
Facility: Providence Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,873
- Cash Discount Price: $3,688
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $4,000.24 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Early Detection Works | $496 | 12% |
| Aetna | $601 - $3,689 | 15% |
| Comp Alliance - Fka Compresults Worker Compensation | $976 | 24% |
| Medicaid / KanCare | $1,235 | 31% |
| UnitedHealthcare | $1,235 - $5,164 | 31% |
| Healthy Blue | $1,260 - $3,873 | 31% |
| Celtic | $1,260 - $5,902 | 31% |
| Medicare (plans) | $3,689 | 92% |
| Tricare | $3,689 | 92% |
| Midland Care Connection | $3,689 | 92% |
| Cigna | $3,689 | 92% |
| Kansas Superior Select | $3,873 | 97% |
| Corizon | $4,795 | 120% |
| Well Path Prison | $5,164 | 129% |
| Employer Direct Healthcare | $5,164 | 129% |
| Oha Networks | $5,292 | 132% |
| Worker Compensation | $5,456 | 136% |
| Centurion | $5,533 | 138% |
| Naphcare | $5,718 | 143% |
| Blue Cross Blue Shield | $5,902 - $6,824 | 148% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," at Providence Medical Center in Kansas City, KS, the facility's cash median price is $3,688.00, which aligns closely with the state average of $3,688.00. While many commercial payers have negotiated rates ranging from $496 to $6,824, the cash price often serves as a competitive baseline for patients with high-deductible plans or those without insurance. It is important to note that while insurance negotiated rates can be higher than the cash price due to administrative overhead and contract structures, patients should always verify their specific plan's allowed amount before scheduling. Additionally, patients should proactively inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the costly insurance claims cycle.
The Medicare benchmark for this service is $4,000.24, which acts as a scientifically validated baseline for evaluating pricing fairness. Commercial negotiated rates frequently exceed this benchmark, with some payers charging up to $6,824, though the median negotiated rate across all payers is $3,873.00. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, which may hide unbundled charges or services not rendered. If a patient receives a balance bill for an out-of-network service at this in-network facility, they should not pay immediately out of fear of credit damage; instead, they should dispute the bill with their insurer and request