Breast lump removal
Facility: Via Christi Hospital Wichita St Teresa, Inc
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $393
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.10x 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 | $393 | 10% |
Consumer Guidance & Cost Commentary
For the procedure "Breast lump removal" at Via Christi Hospital Wichita St Teresa, Inc, the negotiated rate for Early Detection Works is $393.00, which aligns exactly with the low and high ends of the reported range for this payer. While the facility is a voluntary non-profit church-owned acute care hospital in Wichita, KS, and holds a 4-star rating, specific cash or median paid values are not available in the current data. It is important to note that cash-pay options can sometimes be more affordable than insurance negotiated rates, particularly for patients with high-deductible plans where the insurance allowed amount might exceed the cash price. Patients should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $4,000.24 for this CPT code. The commercial negotiated rate of $393.00 is significantly lower than the Medicare amount, reflecting the standard pricing dynamics where commercial contracts often operate well below federal benchmarks. However, because the data does not provide specific county or state average comparisons for this procedure, patients cannot yet determine if this rate is lower than the regional average. Regardless of the comparison, consumers should avoid balance billing by ensuring they understand their network status, as the No Surprises Act protects against unexpected out-of-network charges for emergency care and non-emergency services at in-network facilities. If a large bill arrives, patients should request a full itemized audit to verify that no unbundled codes or services not rendered have been included.