Breast lump removal
Facility: Fredonia Regional Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $2,998
- Cash Discount Price: $3,331
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $1,648 - $4,143 | 41% |
| Veterans Programs - All Plans | $1,699 | 42% |
| UnitedHealthcare | $1,699 - $2,998 | 42% |
| Aetna | $1,699 - $2,998 | 42% |
| Cigna | $2,998 | 75% |
| Meritain-All Plans | $2,998 | 75% |
| Reserve National-All Plans | $2,998 | 75% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Fredonia Regional Hospital in Fredonia, KS, the cash median price is $3,331. This amount matches the facility's cash median and is significantly lower than the Medicare benchmark of $4,000.24, which serves as the federal baseline for this service. While the facility is a Critical Access Hospital owned by the local government, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this specific case, the lowest negotiated rate found across payers is $2,998, which is actually lower than the cash price, meaning patients with high-deductible plans may save money by using their insurance rather than paying cash directly.
When comparing pricing to broader regional standards, the facility's cash rate of $3,331 is notably higher than the median negotiated rate of $2,998 observed across the seven payers listed for this procedure. Although the data does not provide explicit state or county average comparisons for this specific code, the facility's cash price remains well below the Medicare amount, suggesting a relatively fair baseline for self-pay patients. To potentially reduce costs further, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can offer additional reductions for upfront payment. Additionally, since the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients can rest assured that they will not be billed for the difference between the hospital's chargemaster and their insurance allowed amount for this service.