Breast lump removal
Facility: Scott County Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $4,143
- Cash Discount Price: Unavailable
- 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 | $1,200 - $3,445 | 30% |
| UnitedHealthcare | $1,235 - $5,455 | 31% |
| Humana | $2,412 | 60% |
| Blue Cross Blue Shield | $4,143 | 104% |
| Aetna | $5,168 | 129% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Scott County Hospital in Scott City, KS, has a gross charge of $5,742.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates vary significantly by payer, ranging from $1,200 at Wppa to $5,168 at Aetna. The median negotiated rate across all payers is $4,143.00, which aligns closely with the facility's specific negotiated rate of $4,143.00. It is important to note that cash-pay rates are not available for this service, meaning patients without insurance coverage cannot access a lower self-pay price point.
When evaluating costs, it is helpful to compare these figures against the Medicare benchmark of $4,000.24. The facility's gross charge is 1.0 times the Medicare amount, indicating the listed price is identical to the federal baseline. For patients with high-deductible plans, the lack of a cash price option means they will likely pay the negotiated amount once their deductible is met, rather than a discounted self-pay rate. Since no summary or itemized billing data is provided in this report, patients should request a full itemized CPT-coded bill before finalizing payment to ensure no unbundled codes or services not rendered are included. Additionally, because this is an in-network facility for the listed payers, the No Surprises Act generally protects patients from balance billing for emergency or non-emergency services from out-of-network providers at this location.