Breast lump removal
Facility: Mitchell County Hospital Health Systems
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $495
- Cash Discount Price: $527
- vs. Medicare Baseline: 0.12x 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 |
|---|---|---|
| UnitedHealthcare | $326 - $556 | 8% |
| Aetna | $495 | 12% |
| First Health-All Plans | $495 | 12% |
| Triwest Well Mark All Plans | $497 | 12% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Mitchell County Hospital Health Systems in Beloit, KS, the facility's cash median price is $527.00, which is lower than the gross charge of $585.00. While the facility is a Critical Access Hospital with government-local ownership, the negotiated rates for in-network payers such as UnitedHealthcare, Aetna, and First Health-All Plans range between $495.00 and $497.00. These negotiated amounts are slightly lower than the cash price, meaning patients with active insurance coverage may pay less than those paying out-of-pocket, though this depends on individual plan deductibles and co-pays. It is important to note that cash-pay can sometimes be cheaper for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, so verifying your specific plan's allowed amount before scheduling is essential.
When comparing pricing benchmarks, the Medicare amount for this service is $4,000.24, which serves as a significant baseline for evaluating the facility's rates. The facility's cash median of $527.00 and the median negotiated rate of $495.00 are substantially lower than the Medicare amount, indicating a fair markup relative to the federal government's cost-based reimbursement. The data reflects a vintage of 2026-06 and includes four distinct payers, with UnitedHealthcare covering three plans. Patients should be aware that prompt-pay discounts, typically ranging from 20% to 50%, may be available if settling the bill upfront, but these must be requested before check-in to