Breast lump removal
Facility: Nemaha Valley Community Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $395
- Cash Discount Price: $1,169
- 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 |
|---|---|---|
| Midlands Choice - All Plans | $68 | 2% |
| Va Ccn - All Plans | $368 | 9% |
| Humana | $368 | 9% |
| Aetna | $371 - $438 | 9% |
| Celtic Comm Exch - All Plans | $386 | 10% |
| Partners Direct Health - All Plans | $405 | 10% |
| Blue Cross Blue Shield | $571 | 14% |
| Health Partners - All Plans | $720 | 18% |
| Multiplan - All Plans | $779 | 19% |
Consumer Guidance & Cost Commentary
For the CPT code 19120 (Breast lump removal) at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $1,169.00, which is lower than the facility's gross charge of $1,299.00. While the hospital's negotiated rates with insurance payers range from $368 to $779, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket and asking for a prompt-pay discount before scheduling. It is important to note that the facility's negotiated rates are significantly lower than the Medicare benchmark of $4,000.24, reflecting the typical administrative markup inherent in commercial insurance contracts where rates can average 200% to 300% of Medicare costs.
Patients should be aware that balance billing is generally prohibited for emergency services and non-emergency care at in-network facilities under the No Surprises Act, though unexpected ancillary charges from out-of-network providers can still occur. If you receive a bill that seems unusually high, request a formal itemized audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes. Additionally, since the facility is a voluntary non-profit critical access hospital, you should verify your specific plan's allowed amount and check for self-pay discounts directly with the billing department before finalizing payment, ensuring you are not paying the full chargemaster rate or signing away rights to dispute out-of-network costs.