Breast lump removal
Facility: Community Memorial Healthcare, Inc.
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $472
- Cash Discount Price: $1,100
- 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 | $265 - $405 | 7% |
| Aetna | $368 - $880 | 9% |
| Blue Cross Blue Shield | $571 - $4,143 | 14% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash median price of $1,100.00, which matches the facility's gross charge. This cash rate is significantly lower than the median negotiated rates paid by major insurers, such as UnitedHealthcare ($265–$405), Aetna ($368–$880), and Blue Cross Blue Shield ($571–$4,143). While commercial insurance contracts often result in higher allowed amounts due to administrative overhead and contract dynamics, patients with high-deductible plans may find the cash price more affordable if their out-of-pocket costs exceed the negotiated rate. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final balance before any insurance claim is processed.
When evaluating costs, it is important to compare rates against objective benchmarks rather than the facility's inflated chargemaster list. The Medicare amount for this procedure is $4,000.24, serving as a scientifically validated baseline for the true cost of delivery. Commercial negotiated rates frequently exceed 200% of Medicare rates, whereas fair pricing is typically defined as 120% to 150% of this benchmark. Additionally, patients should be aware of balance billing risks if care involves out-of-network providers or ancillary services, even at an in-network facility. If a surprise bill arises, consumers should dispute it in writing and request a No Surprises Act audit rather than accepting summary invoices or signing away rights via consent waivers.