Breast lump removal
Facility: Goodland Regional Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $4,143
- Cash Discount Price: $4,766
- vs. Medicare Baseline: 1.04x 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 |
|---|---|---|
| Wppa | $1,959 - $7,456 | 49% |
| UnitedHealthcare | $2,074 - $7,456 | 52% |
| Blue Cross Blue Shield | $4,143 | 104% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Goodland Regional Medical Center in Goodland, KS, the facility's cash median rate is $4,766.00, which is lower than the gross charge of $5,295.00. While the facility is a Critical Access Hospital with government-local ownership, the data provided does not include specific Goodland or Kansas county averages for this procedure, so a direct comparison to local pricing benchmarks cannot be made. However, the Medicare benchmark for this service is $4,000.24, which serves as the objective baseline for evaluating pricing markups. In this instance, the cash rate exceeds the Medicare amount by approximately 19%, which falls within the typical range where commercial rates may be higher than the federal cost baseline due to administrative overhead and risk adjustment.
Commercial insurance rates vary significantly among payers, with negotiated amounts ranging from $4,143.00 for Blue Cross Blue Shield to $7,456.00 for Wppa and UnitedHealthcare. It is important to note that while in-network insurance offers protection against balance billing, the negotiated rates can sometimes exceed the cash price, particularly for patients with high-deductible plans who may not yet have met their out-of-pocket threshold. To potentially lower costs, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid in full upfront. Additionally, since over 80% of hospital bills contain errors, requesting a detailed, itemized audit of the statement before payment is a critical step to ensure