Breast lump removal
Facility: Minneola District Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,722
- Cash Discount Price: $2,141
- vs. Medicare Baseline: 0.93x 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 |
|---|---|---|
| Va Community Care Program-All Plans | $391 - $3,722 | 10% |
| Humana | $391 - $3,722 | 10% |
| UnitedHealthcare | $391 - $5,555 | 10% |
| Providrs Care Network-All Plans | $477 - $4,722 | 12% |
| Corporate Plan Management-All Plans | $477 - $4,722 | 12% |
| Preferred Health Care (Coventry)-All Other Plans | $505 - $5,000 | 13% |
| Triwest-All Plans | $505 - $5,000 | 13% |
| Phc (Coventry) Leased Network | $533 - $5,277 | 13% |
| Aetna | $533 - $5,555 | 13% |
| Health Partners Of Kansas-All Plans | $533 - $5,277 | 13% |
| Medicaid / KanCare | $561 - $5,555 | 14% |
| Blue Cross Blue Shield | $4,143 | 104% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," at Minneola District Hospital, the cash median price is $2,141.00, which is lower than the facility's gross charge of $3,058.00. While the hospital's negotiated rates with insurance payers range from $391 to $5,555, the cash price may be more cost-effective for patients with high-deductible plans or those without insurance, as the cash rate is significantly below the median negotiated amount of $3,722.00. Patients should verify their specific plan's deductible status before scheduling, as paying out-of-pocket might result in a lower total cost than the insurance allowed amount, especially if the patient has not yet met their annual deductible threshold.
To ensure you are not overcharged, it is important to distinguish between the hospital's gross charges and the actual rates you will pay. The facility's gross charge of $3,058.00 serves as a baseline list price, but commercial payers negotiate lower rates that often exceed the cash price due to administrative costs and contract structures. If you receive a bill from an out-of-network provider, you may be subject to balance billing for the difference between the provider's full charge and your insurance payment, though the No Surprises Act protects you from such surprise bills for emergency care and non-emergency services at in-network facilities. Always request a detailed, itemized bill to review specific CPT codes and identify any unbundled charges or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute.