Breast lump removal
Facility: Cloud County Health Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,504
- Cash Discount Price: $776
- vs. Medicare Baseline: 0.88x 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 |
|---|---|---|
| Pponext-All Plans | $485 - $3,638 | 12% |
| Mpi-All Plans | $497 - $3,638 | 12% |
| Aetna | $3,447 - $3,562 | 86% |
| Health Partners - All Plans | $3,638 | 91% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Cloud County Health Center in Concordia, KS, the facility's cash median price is $776.00, which is significantly lower than the state average of $1,108.00. While the facility's negotiated rates with major payers like Aetna and Health Partners range from $3,447 to $3,638, these amounts are notably higher than the cash price. This pricing structure highlights a common scenario where patients with high-deductible plans might save money by paying the cash price of $776.00 directly, as the insurance negotiated rates often exceed the cash rate. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost.
It is important to distinguish between the facility's gross charges and the actual amounts paid, as commercial rates often include administrative overhead that inflates the baseline price. In this case, the Medicare benchmark amount of $4,000.24 serves as a scientifically validated cost baseline, revealing that the facility's negotiated rates are well above the true cost of care. Consumers should avoid comparing discounts against the inflated chargemaster list and instead focus on the Medicare rate to understand the actual markup. Furthermore, if a patient receives an itemized bill, they should request a full line-by-line audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes that can be corrected through a formal written dispute.