Breast lump removal
Facility: Logan County Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $6,299
- Cash Discount Price: $2,670
- vs. Medicare Baseline: 1.57x 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 |
|---|---|---|
| Humana | $3,775 | 94% |
| Blue Cross Blue Shield | $4,143 | 104% |
| Health Partners - All Plans | $8,455 | 211% |
| Medicaid / KanCare | $8,900 | 222% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Logan County Hospital in Oakley, KS, lists a gross charge of $8,900. The facility's cash median rate is $2,670, which is significantly lower than the negotiated rates paid by major payers such as Humana ($3,775) and Blue Cross Blue Shield ($4,143). This price difference highlights that cash-pay options can be substantially cheaper for patients with high-deductible plans, as the insurance negotiated rates often exceed the cash price. While the facility is a Critical Access Hospital with government-local ownership, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final cost.
When evaluating the cost of this procedure, it is important to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster. The Medicare amount for this service is $4,000.24, and the facility's cash rate of $2,670 is below this benchmark, indicating a fair price structure. Conversely, the median negotiated rate of $6,299 exceeds the Medicare amount by approximately 58%, reflecting the administrative overhead and contract dynamics inherent in commercial insurance billing. To ensure you are not overcharged, we recommend requesting an itemized billing audit to review all line items and confirm that no unbundled codes or services not rendered have inflated the total before finalizing payment.