Breast lump removal
Facility: Girard Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $368
- Cash Discount Price: $803
- vs. Medicare Baseline: 0.09x 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 |
|---|---|---|
| Ambetter / Centene | $368 | 9% |
| Kansas Superior Select-All Plans | $368 | 9% |
| Aetna | $368 | 9% |
| Blue Cross Blue Shield | $368 | 9% |
| Humana | $368 | 9% |
| UnitedHealthcare | $368 - $519 | 9% |
| Medicare (plans) | $368 | 9% |
| Uhhis-All Plans | $519 | 13% |
| Multiplan-All Plans | $1,238 | 31% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Girard Medical Center in Girard, KS, lists a gross charge of $1,338.00, which is significantly higher than the facility's cash median of $803.00 and the median negotiated rate of $368.00. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures. In this case, the cash price of $803.00 is notably lower than the Medicare benchmark of $4,000.24, suggesting that for patients with high-deductible plans or those without insurance, paying the cash median could result in substantial savings compared to standard insurance billing.
It is important to distinguish between the facility's gross charges and the actual amounts paid by insurers, as the latter are subject to negotiated caps that can vary widely. For this procedure, the lowest negotiated rate among payers is $368.00, while the highest is $1,238.00, with UnitedHealthcare and Uhhis-All Plans showing a range up to $519.00. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates do not guarantee the lowest possible price, and some commercial contracts may still result in higher out-of-pocket costs than the cash option. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with