Breast lump removal
Facility: Saint Luke'S South Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,333
- Cash Discount Price: $12,870
- vs. Medicare Baseline: 0.83x 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 |
|---|---|---|
| Medicaid / KanCare | $1,235 - $4,897 | 31% |
| Humana | $2,250 - $4,941 | 56% |
| Cigna | $2,250 - $6,958 | 56% |
| UnitedHealthcare | $2,321 - $3,874 | 58% |
| Blue Cross Blue Shield | $3,215 - $3,782 | 80% |
| Commercial-Contracted [8000] | $3,435 | 86% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Saint Luke's South Hospital in Overland Park, KS, the facility's cash median price is $12,870. This cash rate is significantly lower than the facility's gross charge of $21,450 and the Medicare benchmark of $4,000.24. While the facility offers a negotiated rate of $3,333, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $12,870. It is important to note that the facility's cash median is higher than the state average for this procedure, though specific county averages were not provided in the data. To secure the lowest possible rate, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%.
Insurance payers have negotiated rates ranging from $1,235 for Medicaid/KanCare plans to $6,958 for Cigna, with Humana and UnitedHealthcare falling between $2,250 and $3,874. These negotiated amounts are generally lower than the cash price, but patients must be aware that balance billing could occur if their specific plan allows it or if ancillary services are out-of-network. Under the No Surprises Act, balance billing for emergency care and non-emergency services at in-network facilities is prohibited, so patients should verify their network status and request a waiver of insurance submission if they choose to pay cash. Finally, because over 80% of hospital bills contain errors