Breast lump removal
Facility: Osborne County Memorial Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,017
- Cash Discount Price: $2,834
- vs. Medicare Baseline: 0.75x 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 | $2,534 | 63% |
| Health Partners Of Kansas | $2,867 | 72% |
| Wppa | $3,167 | 79% |
| Blue Cross Blue Shield | $3,267 | 82% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal, the gross charge at Osborne County Memorial Hospital is $3,334.00. While the facility is a Critical Access Hospital in Osborne, Kansas, the data provided does not include specific county or state average rates for this procedure, so a direct comparison to regional pricing benchmarks cannot be made. The cash median price for this service is listed at $2,834.00, which is lower than the gross charge. Patients with high-deductible plans may find paying the cash median rate more cost-effective than using insurance, as commercial negotiated rates for this code range from $2,534 to $3,267 depending on the payer, and these rates often exceed the cash price.
The Medicare benchmark for this service is $4,000.24, indicating that the gross charge is 83% of the Medicare amount. The median negotiated rate across payers is $3,017.00, which is higher than the cash median. It is important to note that while the facility is a government-owned Critical Access Hospital, patients should verify their specific plan details before scheduling, as insurance coverage and deductibles vary. To potentially reduce costs, patients should inquire about "self-pay" or "prompt-pay" discounts before check-in, as hospitals often offer fee reductions for upfront payment that bypass the administrative overhead of insurance billing. Additionally, patients should request a full itemized bill to ensure all charges are accurate and to identify any unbundled codes or services not rendered.