Breast lump removal
Facility: Kiowa District Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $906
- Cash Discount Price: $763
- vs. Medicare Baseline: 0.23x 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 |
|---|---|---|
| Tricare | $372 | 9% |
| UnitedHealthcare | $763 - $954 | 19% |
| Health Partners Of Ks-All Plans | $840 | 21% |
| Humana | $861 | 22% |
| Multiplan-All Plans | $897 | 22% |
| Gbs Insurance - All Plans | $897 | 22% |
| Aetna | $906 | 23% |
| Medicare (plans) | $906 | 23% |
| Triwest-All Plans | $906 | 23% |
| Medicaid / KanCare | $954 | 24% |
| Providers Care (Wppa)-All Plans | $1,431 | 36% |
| Liberty Healthshare-All Plans | $1,541 | 39% |
| Blue Cross Blue Shield | $2,355 | 59% |
| Healthchoice-All Plans | $5,150 | 129% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," at Kiowa District Hospital in Kiowa, KS, the cash price is $763.00, while the median negotiated rate across payers is $906.00. This cash price is notably lower than the facility's gross charge of $954.00 and aligns closely with the state average for this procedure. Patients with high-deductible plans may find paying the cash rate of $763.00 more cost-effective than using insurance, as the negotiated rates often exceed the cash price. It is important to note that while the facility is a Critical Access Hospital owned by a Government Hospital District, the specific negotiated rates vary significantly by payer, ranging from $372 for Tricare to $5,150 for Healthchoice-All Plans.
When comparing this facility to broader benchmarks, the Medicare amount for this service is $4,000.24, which serves as the objective baseline for evaluating pricing markups. Commercial negotiated rates here average approximately 226% of the Medicare rate, which is higher than the typical fair pricing range of 120% to 150% of Medicare. To potentially reduce costs, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass administrative fees and lower the final bill. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify their network status and request an itemized bill to ensure no unexpected charges are included.