Breast lump removal
Facility: Clay County Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $714
- Cash Discount Price: $768
- vs. Medicare Baseline: 0.18x 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 |
|---|---|---|
| Health Partners - All Plans | $75 - $730 | 2% |
| Multiplan- All Plans | $371 - $730 | 9% |
| UnitedHealthcare | $464 - $730 | 12% |
| Aetna | $714 | 18% |
| Wppa/Providrs Care- All Plans | $714 | 18% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Clay County Medical Center in Clay Center, KS, lists a cash median price of $768.00, which matches the facility's gross charge. This cash rate is significantly lower than the typical negotiated rates paid by major insurers, such as UnitedHealthcare and Multiplan, which average $714.00 to $730.00 depending on the specific plan. While commercial insurance contracts often cap payments at these negotiated levels, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds the cash rate. It is important to note that the facility is a Critical Access Hospital with government-local ownership, and patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full chargemaster rate.
When evaluating the cost against federal benchmarks, the Medicare amount for this procedure is $4,000.24, which serves as a baseline for fair pricing. Commercial negotiated rates in this region generally fall between 120% and 150% of the Medicare rate, whereas the cash price here is approximately 19% of the Medicare amount, indicating a substantial difference in pricing structures. Patients should be aware of balance billing risks if they receive care from out-of-network providers, though the No Surprises Act protects against such billing for emergency services at in-network facilities. To avoid unexpected costs, consumers should request an itemized bill to verify that no unbundled codes or services not rendered are included, and they should dispute any summary bills that obscure individual charges before making a payment.