Breast lump removal
Facility: Menorah Medical Center
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 - $6,496 | 31% |
| Healthyblue | $1,260 | 31% |
| Medicaid / KanCare | $1,272 | 32% |
| Unicare | $1,284 | 32% |
| Aetna | $1,284 - $7,996 | 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, "Breast lump removal," at Menorah Medical Center in Overland Park, KS, the facility's negotiated rates range from $1,235 to $14,300 across 17 different payers. While the lowest negotiated rate of $1,235 is significantly lower than the facility's median negotiated amount of $4,630, it is important to note that cash prices are not listed for this procedure. In many cases, cash-pay options can be more affordable for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price. Since the facility is a proprietary acute care hospital, patients are encouraged to contact the billing department directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% when paid in full upfront.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare amount for this code is $4,000.24, and the facility's negotiated rates generally fall within the typical commercial range of 120% to 300% of this baseline. For instance, the highest negotiated rate of $14,300 with Wppa Providers Care Network represents a substantial markup compared to the Medicare rate, whereas the lowest rate of $1,235 with Amerigroup is notably lower. Patients should verify their specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting the deductible can result in higher out-of-pocket costs than anticipated.