Breast lump removal
Facility: Hospital District #6 Patterson Health Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $498
- Cash Discount Price: $496
- 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 | $375 - $620 | 9% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," the Hospital District #6 Patterson Health Center in Anthony, KS, lists a gross charge of $620.00, which aligns with the highest end of the negotiated range for UnitedHealthcare plans in this area. While the facility's cash median rate is $496.00, the Medicare benchmark for this service is significantly higher at $4,000.24, indicating that the commercial rates are well below the federal baseline. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price, though in this specific case, the cash rate is already lower than the UnitedHealthcare high-end estimate. Patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to ensure they are receiving the lowest possible out-of-pocket rate.
This procedure is categorized under Critical Access Hospitals, and the facility is owned by a Government Hospital District. Although the data does not provide specific county or state average comparisons for this exact code, the transparent pricing structure allows consumers to compare the facility's $498.00 median negotiated rate against their own plan's allowed amount. If you receive a bill that exceeds these rates, you may be subject to balance billing if the provider is out-of-network, though the No Surprises Act protects against such charges for emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, always request an itemized bill to review every line item and dispute any charges for services not rendered or unbundled components before finalizing payment.