Breast lump removal
Facility: Trego County Lemke Memorial Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $2,502
- Cash Discount Price: $2,502
- vs. Medicare Baseline: 0.63x 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 |
|---|---|---|
| Humana | $1,443 | 36% |
| Tricare | $1,558 | 39% |
| Medicaid / KanCare | $1,825 - $2,944 | 46% |
| Va Ccn - All Plans | $1,825 | 46% |
| Aetna | $1,825 - $2,650 | 46% |
| UnitedHealthcare | $1,825 - $2,944 | 46% |
| Ambetter / Centene | $2,008 | 50% |
| Health Partners - All Plans | $2,797 | 70% |
| Healthy Blue Mcaid - All Plans | $2,944 | 74% |
| Blue Cross Blue Shield | $5,666 | 142% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Trego County Lemke Memorial Hospital in Wakeeney, KS, the facility's cash price of $2,502.00 is notably lower than the median negotiated rates paid by most insurance payers, which range from $1,825.00 to $5,666.00. While the facility is a Critical Access Hospital with government local ownership, its cash rate exceeds the state average of $2,502.00 and the county average of $2,502.00, suggesting that for patients with high-deductible plans or those without insurance, paying cash directly may result in lower out-of-pocket costs compared to insurance claims that could trigger balance billing. Patients should verify their specific plan's deductible status before scheduling, as some in-network commercial rates, such as those from UnitedHealthcare or Blue Cross Blue Shield, may exceed the cash price, potentially leading to unexpected balances if the patient's insurance does not cover the full amount.
To ensure you are not overcharged, it is critical to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill from an out-of-network provider, even at an in-network facility, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services. Additionally, you should inquire about prompt-pay discounts, which can reduce the cash price by 20% to 50% if paid upfront, bypassing the administrative costs associated with