Breast lump removal
Facility: Jewell County Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $892
- Cash Discount Price: $771
- 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 |
|---|---|---|
| Rural Carriers - All Plans | $319 - $1,428 | 8% |
| Aetna | $338 - $1,512 | 8% |
| Meritain - All Plans | $338 - $1,512 | 8% |
| First Health - All Plans | $356 - $1,596 | 9% |
| Midlands Choice - All Plans | $356 - $1,596 | 9% |
| Cigna | $356 - $1,596 | 9% |
| UnitedHealthcare | $356 - $1,596 | 9% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Jewell County Hospital in Mankato, Kansas, the facility's cash median rate is $771.00, while the median negotiated rate for commercial payers is $892.00. This procedure is billed at a gross amount of $1,028.00, which is significantly higher than the cash price. For patients with high-deductible plans, paying the cash price of $771.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates from carriers like Aetna, Cigna, and UnitedHealthcare can exceed $1,500 depending on the specific plan. Since this facility is a Critical Access Hospital with government-local ownership, patients should proactively ask about self-pay or prompt-pay discounts before scheduling, as these incentives can reduce the final bill by 20% to 50%.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's gross charges. The Medicare amount for this procedure is $4,000.24, and the facility's cash rate is approximately 19% of the Medicare amount, whereas the median negotiated rate is roughly 22% of the Medicare amount. This comparison reveals that the commercial rates are not marked up excessively relative to the federal baseline, which is calculated using local wage indexes and actual provider costs. To ensure you are not overcharged, always request a full itemized bill that lists specific CPT codes and unit costs, avoiding summary bills that obscure individual charges, and verify your deductible status before using insurance to prevent