Breast lump removal
Facility: Wamego Health Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $473
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.12x 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 |
|---|---|---|
| UnitedHealthcare | $450 | 11% |
| Aetna | $468 | 12% |
| Medicaid / KanCare | $468 - $472 | 12% |
| Providrs Care | $627 | 16% |
| Tricare | $1,863 | 47% |
| Blue Cross Blue Shield | $5,441 - $5,728 | 136% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal, the negotiated rates at Wamego Health Center in Wamego, KS, range from $450 to $1,863 depending on the payer. The lowest negotiated amount is $450 for UnitedHealthcare, while the highest is $1,863 for Tricare. When compared to the Medicare benchmark of $4,000.24, the facility's negotiated rates are significantly lower, with the median negotiated rate of $473 representing a substantial discount relative to the federal baseline. This aligns with the principle that commercial rates are often negotiated to be well below the chargemaster, though they can still exceed the cash price for patients with high-deductible plans.
Patients should be aware that while in-network insurance provides a ceiling on costs, the actual out-of-pocket expense depends heavily on individual plan deductibles and copays. For instance, the cash median is not available for this service, but patients should explicitly ask the facility about self-pay or prompt-pay discounts, which can reduce bills by 20% to 50% if paid upfront. Additionally, since this is a Critical Access Hospital, the pricing structure is designed to reflect local wage indexes and actual costs, making the Medicare rate a reliable reference point for evaluating the facility's pricing fairness. Always request an itemized bill before payment to ensure no unbundled charges or services not rendered are included.