Breast lump removal
Facility: Hiawatha Community Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $552
- Cash Discount Price: $875
- vs. Medicare Baseline: 0.14x 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 |
|---|---|---|
| Ambetter / Centene | $341 | 9% |
| Humana | $368 | 9% |
| UnitedHealthcare | $368 - $526 | 9% |
| Aetna | $368 - $562 | 9% |
| Centrus Health Direct - All Plans | $441 | 11% |
| Preferred Hlth - All Plans | $514 | 13% |
| Multiplan - All Plans | $552 | 14% |
| Oscar - All Plans | $588 | 15% |
| Wppa Providrs Care - All Plans | $606 | 15% |
| Cigna | $720 | 18% |
| Healthy Blue Mcaid - All Plans | $803 - $947 | 20% |
| Midlands Choice - All Plans | $903 | 23% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal procedure at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $875.00. This cash rate is significantly lower than the facility's gross charge of $875.00, which serves as the baseline for insurance billing. While the hospital is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, the median negotiated rate across payers is $552.00, yet individual negotiated amounts range from $341 to $947 depending on the specific insurance plan. In this specific case, the cash price of $875.00 is higher than the lowest negotiated rates found (e.g., $341 for Ambetter / Centene), meaning patients with high-deductible plans or those who have not met their out-of-pocket maximum might find paying cash directly more cost-effective than relying on insurance, provided they qualify for the cash rate.
To minimize unexpected costs, patients should proactively request a "self-pay" or "prompt-pay" discount before scheduling services, as hospitals often offer fee reductions for upfront payments that bypass the standard insurance billing cycle. It is also important to understand that while the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still verify their network status and request an itemized bill to avoid errors. Although the data does not provide specific county or state average comparisons for this procedure, the facility's Medicare benchmark of $4