Breast lump removal
Facility: Rawlins County Health Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $894
- Cash Discount Price: $874
- vs. Medicare Baseline: 0.22x 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 |
|---|---|---|
| UnitedHealthcare | $894 | 22% |
| Blue Cross Blue Shield | $4,143 | 104% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," at Rawlins County Health Center in Atwood, Kansas, the cash median price is $874.00, which is lower than the negotiated rates of $894.00 for UnitedHealthcare and $4,143.00 for Blue Cross Blue Shield. This price difference highlights a common billing dynamic where paying out-of-pocket upfront can result in a lower total cost than what insurance plans negotiate, particularly if a patient has a high deductible or limited coverage. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should verify their specific plan details before scheduling, as the negotiated rates for in-network payers often include administrative overhead that exceeds the direct cash price.
It is important to distinguish between the facility's gross charge of $1,028.00 and the actual amounts billed to patients. The Medicare benchmark for this service is $4,000.24, which serves as a scientifically validated baseline for the true cost of care, revealing that commercial negotiated rates can sometimes approach or exceed Medicare amounts depending on the payer. For instance, the Blue Cross Blue Shield negotiated rate of $4,143.00 is significantly higher than the Medicare amount, whereas the UnitedHealthcare rate of $894.00 is lower. Consumers should be aware of balance billing risks if they receive care from out-of-network providers, though the No Surprises Act offers protections for emergency services at in-network facilities. To minimize costs, patients are encouraged to request a prompt-pay discount or self-pay rate directly from the hospital before check-in, as these upfront payments