Breast lump removal
Facility: Great Plains Of Sabetha
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $600
- Cash Discount Price: $1,911
- 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 |
|---|---|---|
| Celtic Mcr Adv | $312 - $1,675 | 8% |
| Aetna | $315 - $3,254 | 8% |
| UnitedHealthcare | $368 - $3,222 | 9% |
| Celtic Comm Exchange-All Other Plans | $390 - $2,094 | 10% |
| Medicaid / KanCare | $450 - $3,222 | 11% |
| Great West Healthcare-All Plans | $510 - $2,739 | 13% |
| Century/Wppa/Providers-All Plans | $540 - $3,061 | 13% |
| Cigna | $570 - $3,061 | 14% |
| Multiplan-Phcs-All Plans | $570 - $3,061 | 14% |
| Humana | $570 - $3,061 | 14% |
| Federated Mutual Ins-All Plans | $576 - $3,093 | 14% |
| Blue Cross Blue Shield | $600 - $3,222 | 15% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Great Plains Of Sabetha in Sabetha, KS, has a cash price of $1,911.00, which matches the facility's cash median. While the facility's negotiated rates with major payers like Aetna and UnitedHealthcare range from $315 to over $3,000, the cash price is often the most transparent benchmark for patients. It is important to note that cash-pay can sometimes be cheaper for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, though in this specific case, the cash rate is significantly higher than the median negotiated amount of $576.00. Patients should verify their specific plan's allowed amount and check with the hospital for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final cost.
This procedure is billed under the Critical Access Hospital status in Kansas, and while the data does not provide specific county or state average comparisons for this exact code, the facility's pricing structure reflects standard commercial billing practices. Under the No Surprises Act, patients are protected from balance billing for out-of-network providers at in-network facilities, meaning they should not be billed for the difference between the chargemaster and their insurance allowed amount for emergency or non-emergency services. If a patient receives an unexpected bill, they should request an itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected. Finally, comparing the facility's rates to the Medicare benchmark of $4,000.24