Breast lump removal
Facility: Kansas City Orthopaedic Institute
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $8,796
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.20x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 220% of the Medicare baseline (a markup of 120%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| UnitedHealthcare | $3,383 | 85% |
| Aetna | $3,383 | 85% |
| Cigna | $3,602 | 90% |
| Blue Cross Blue Shield | $8,796 | 220% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing breast lump removal, the Kansas City Orthopaedic Institute in Leawood, KS, has a negotiated rate of $8,796.00. This rate is significantly higher than the state average, which is 2.2 times the Medicare benchmark of $4,000.24. While the facility is owned by physicians and serves as an acute care hospital, the data indicates that cash and median paid amounts are not currently available for this specific service. In cases where a patient has a high deductible, paying the cash price directly can sometimes be more cost-effective than relying on insurance, provided the negotiated rate exceeds the cash price. However, since cash figures are not listed here, patients should verify current self-pay or prompt-pay discounts directly with the hospital before scheduling to ensure they are not paying the full negotiated amount.
It is important to understand that the $8,796.00 figure represents the contractually agreed-upon rate that commercial payers like UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield will pay, which often includes administrative costs and network tiering dynamics. Patients should be aware that assuming an in-network rate is the lowest possible price can be misleading, as different insurers may negotiate different ceilings. Furthermore, if a patient receives care from an out-of-network provider at this facility, they could face balance billing for the difference between the provider's full charge and the insurance allowed amount, though federal protections like the No Surprises Act may limit this for emergency or non-emergency services at in-network facilities. To avoid unexpected costs, consumers should request a detailed, itemized billing audit to identify any errors