Breast lump removal
Facility: Wilson Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $6,369
- Cash Discount Price: $5,971
- vs. Medicare Baseline: 1.59x 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 |
|---|---|---|
| Blue Cross Blue Shield | $2,355 - $7,961 | 59% |
| Ambetter / Centene | $4,219 - $7,961 | 105% |
| UnitedHealthcare | $4,219 - $7,404 | 105% |
| Aetna | $4,219 - $7,961 | 105% |
| Tricare | $4,219 | 105% |
| Humana | $4,219 | 105% |
| Cigna | $6,369 | 159% |
| Mulitplan-All Plans | $7,324 | 183% |
| Health Partners-All Plans | $7,324 | 183% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Wilson Medical Center in Neodesha, KS, the facility's cash price of $5,971 is notably lower than the median negotiated rate of $6,369 paid by insurance carriers. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that commercial payers like Blue Cross Blue Shield and Aetna have negotiated rates ranging from $4,219 to $7,961, which often exceed the cash price. This pricing structure highlights a common billing scenario where paying out-of-pocket can result in immediate savings compared to the higher amounts insurance plans agree to pay, particularly if a patient has a high deductible or is self-insured.
To maximize potential savings, patients should explicitly ask the billing department about "prompt-pay" discounts, which can reduce the total bill by 20% to 50% for upfront payments, effectively lowering the cost below the cash median. Additionally, since the Medicare benchmark for this service is $4,000.24, the facility's cash rate represents a markup of approximately 49% over the federal baseline, which aligns with fair pricing standards rather than the 200% to 300% markups often seen in commercial contracts. Consumers are advised to request a full itemized bill before scheduling to verify that no unnecessary services are included and to confirm whether any "self-pay" or "prompt-pay" incentives are available prior to check-in.