Breast lump removal
Facility: Holton Community Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $651
- Cash Discount Price: $888
- vs. Medicare Baseline: 0.16x 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 |
|---|---|---|
| Aetna | $354 - $3,535 | 9% |
| UnitedHealthcare | $354 - $3,535 | 9% |
| Medicaid / KanCare | $356 - $3,535 | 9% |
| Humana | $358 - $1,892 | 9% |
| Kansas Superior Select - All Plans | $361 - $1,911 | 9% |
| Preferred Health Freedom | $554 - $2,934 | 14% |
| Preferred Health Fn Select - All Other Plans | $554 - $2,934 | 14% |
| Preferred Health Professionals | $554 - $2,934 | 14% |
| Wppa Providers - All Plans | $635 - $3,358 | 16% |
| Blue Cross Blue Shield | $2,355 | 59% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal procedure at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $888.00, which is notably lower than the state average of $1,184.00. While the hospital's negotiated rates with major payers like Aetna and UnitedHealthcare range from $354 to $3,535, these amounts often exceed the cash price, making self-pay a potentially more cost-effective option for patients with high-deductible plans. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly claims processing and administrative overhead.
When comparing this facility's pricing to the broader market, it is important to note that the hospital's cash rate is significantly lower than the Medicare benchmark of $4,000.24, which serves as a scientifically validated baseline for the true cost of care. Although the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that balance billing can still occur if out-of-network ancillary services are used, even at an in-network facility. To avoid unexpected costs, consumers should demand a full itemized billing audit before paying any invoice, ensuring that all charges are accurate and that no unbundled codes or services not rendered are included in the final statement.