Breast lump removal
Facility: Phillips County Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $440
- Cash Discount Price: $374
- vs. Medicare Baseline: 0.11x 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 | $352 - $440 | 9% |
| Blue Cross Blue Shield | $356 - $4,787 | 9% |
| Health Partners-All Plans | $440 | 11% |
| Medicaid / KanCare | $440 | 11% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Phillips County Hospital in Phillipsburg, Kansas, the facility's negotiated rates range from $352 to $478.70 depending on the insurance plan, with a median negotiated amount of $440.00. This facility is a Critical Access Hospital owned by the local government, and while its cash price of $374.00 is lower than the negotiated rates, patients with high-deductible plans may find paying cash directly more cost-effective if their insurance negotiated rate exceeds the cash price. It is important to note that the facility does not list a specific self-pay or prompt-pay discount in this data, so patients should contact the billing department directly to inquire about potential fee reductions for upfront payment.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $4,000.24, which serves as the objective baseline for pricing. The facility's gross charge of $440.00 is significantly lower than the Medicare rate, indicating a pricing structure that is well below the typical commercial markup often seen in the industry. While specific state or county average comparisons are not provided in this dataset, the transparent reporting of the low gross charge relative to the Medicare benchmark highlights a fair pricing model. Consumers are advised to request an itemized bill before payment to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.