Breast lump removal
Facility: Hamilton County Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $615
- Cash Discount Price: $647
- vs. Medicare Baseline: 0.15x 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 | $366 | 9% |
| First Health Coventry - All Plans | $550 | 14% |
| UnitedHealthcare | $615 | 15% |
| Cigna | $615 | 15% |
| Blue Cross Blue Shield | $1,119 - $4,143 | 28% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Hamilton County Hospital in Syracuse, KS, the cash price is $647.00, which matches the facility's median negotiated rate of $615.00. While the gross charge listed is $647.00, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures; however, in this specific instance, the cash price is the most affordable option available. The facility is a Critical Access Hospital with government-local ownership, and while the data does not provide specific county or state average comparisons for this procedure, patients are encouraged to verify their plan's allowed amount before scheduling to ensure they are not paying more than the insurer's contracted ceiling.
It is important to note that Medicare allows a payment of $4,000.24 for this service, which serves as a benchmark for fair pricing, though commercial rates are typically higher. If you have a high-deductible plan, paying the cash price of $647.00 upfront may be more cost-effective than relying on insurance, especially if your deductible has not yet been met or if the negotiated rate exceeds your out-of-pocket maximum. Before your visit, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window. Additionally, if you have insurance, ensure you sign a waiver of insurance submission to prevent the hospital from automatically billing your plan, which could void any cash discount you negotiated.