Breast lump removal
Facility: Ellsworth County Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $835
- Cash Discount Price: $879
- vs. Medicare Baseline: 0.21x 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 | $258 - $835 | 6% |
| Healthy Blue Mcr Adv | $258 | 6% |
| UnitedHealthcare | $258 - $879 | 6% |
| Triwest -All Plans | $258 | 6% |
| Va Ccn-All Plans | $258 | 6% |
| Aetna | $791 | 20% |
| First Health - All Plans | $791 | 20% |
| Cigna | $835 | 21% |
| Medicaid / KanCare | $879 | 22% |
| Healthy Blue Mcaid- All Other Plans | $879 | 22% |
| Coventry Mcaid-All Plans | $879 | 22% |
| Providers Care-Wppa-All Plans | $1,318 | 33% |
| Blue Cross Blue Shield | $2,237 - $2,355 | 56% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal, the cash price at Ellsworth County Medical Center is $879.00, which matches the facility's negotiated rate for Medicaid and Medicare. This cash price is significantly lower than the commercial negotiated rates seen for many commercial payers, such as Blue Cross Blue Shield, which range up to $2,355.00. While the facility is a Critical Access Hospital in Ellsworth, KS, with a facility rating of 2, patients should be aware that commercial insurance contracts often include administrative overhead that inflates the baseline price by 20% to 40%. In this case, the cash price of $879.00 is notably lower than the commercial negotiated rates, suggesting that paying out-of-pocket might be the most cost-effective option for patients with high-deductible plans who have not yet met their coverage thresholds.
To minimize costs, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the costly insurance billing cycle and administrative fees. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients must still request a formal, itemized billing audit to ensure no errors or unbundled charges exist, as over 80% of hospital bills contain inaccuracies. By comparing the $879.00 cash price directly against the Medicare benchmark of $4,000.24, it becomes clear that the facility's pricing aligns closely with the true cost of care rather than the inflated chargemaster lists often used to