Breast lump removal
Facility: Overland Park Reg Med Ctr
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $4,630
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.16x 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 |
|---|---|---|
| Amerigroup | $1,235 | 31% |
| United | $1,235 - $6,026 | 31% |
| Healthyblue | $1,260 | 31% |
| Medicaid / KanCare | $1,272 | 32% |
| Aetna | $1,284 - $7,996 | 32% |
| Unicare | $1,284 | 32% |
| Humana | $2,835 - $3,508 | 71% |
| Home State Health Plan | $3,428 - $5,141 | 86% |
| Oscar | $4,212 | 105% |
| Universal Healthcare | $4,250 | 106% |
| Multiplan | $4,364 - $6,046 | 109% |
| Nhc Advantage | $4,950 | 124% |
| Cigna | $5,044 - $7,520 | 126% |
| Corvel Corporation | $5,183 | 130% |
| Oha Network | $5,401 | 135% |
| Ambetter / Centene | $9,040 | 226% |
| Wppa Providrs Care Network | $14,300 | 357% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal procedure at Overland Park Reg Med Ctr in Kansas, the facility's negotiated rates range from $1,235 to $14,300 depending on the insurance plan. The lowest negotiated rate of $1,235 is offered by Amerigroup, while the highest is $14,300 from Wppa Providrs Care Network. This procedure carries a Medicare benchmark of $4,000.24, and the facility's median negotiated rate of $4,630.00 is approximately 120% of the Medicare amount. While commercial rates often exceed the Medicare baseline due to administrative costs and contract structures, patients should note that cash-pay options may be more cost-effective if the insurance negotiated rate exceeds the cash price. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can significantly reduce the final amount owed.
The facility is located in Overland Park, Kansas (ZIP 66215), and operates as a Proprietary Acute Care Hospital. While the provided data does not include specific county or state average comparisons for this procedure, the wide variance in negotiated rates across 17 different payers highlights the importance of verifying the specific allowed amount for your plan before scheduling. Patients should avoid accepting summary bills as final invoices and instead request a detailed, itemized CPT-coded statement to identify any unbundled charges or services not rendered. Furthermore, if you are paying out-of-pocket, ensure you sign a waiver of insurance submission to prevent the hospital from automatically billing your insurance, which could void any agreed-upon cash