Breast lump removal
Facility: Republic County Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $2,156
- Cash Discount Price: $1,757
- vs. Medicare Baseline: 0.54x 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 |
|---|---|---|
| Rural Carriers-All Plans | $1,992 | 50% |
| Meritain-All Plans | $2,109 | 53% |
| Aetna | $2,109 | 53% |
| UnitedHealthcare | $2,156 | 54% |
| Midlands Choice-All Plans | $2,226 | 56% |
| First Health-All Plans | $2,226 | 56% |
| Cigna | $2,226 | 56% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Republic County Hospital in Belleville, KS, the facility's negotiated rates for seven commercial payers range from $1,992 to $2,226. These amounts are significantly lower than the facility's gross charge of $2,343.00, demonstrating the impact of insurance contracts that cap billing amounts. However, these negotiated rates are notably higher than the cash price of $1,757.00 and the median paid amount of $2,156.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount, as paying out-of-pocket avoids the administrative overhead and potential deductibles associated with commercial claims.
To optimize costs, patients should verify self-pay or prompt-pay discounts directly with the hospital before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients must still review itemized bills to ensure no unbundled codes or services not rendered have been charged. For context, the facility's pricing is evaluated against national benchmarks; the Medicare amount for this procedure is $4,000.24, which serves as a cost baseline, though commercial rates often differ based on local wage indexes and contract dynamics. Consumers are advised to request a detailed, line-by-line itemized statement to identify any errors or discrepancies before finalizing payment.