Breast lump removal
Facility: Smith County Memorial Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,433
- Cash Discount Price: $3,653
- vs. Medicare Baseline: 0.86x 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 | $2,355 | 59% |
| Medicaid / KanCare | $2,557 - $3,653 | 64% |
| Multiplan-All Plans | $3,287 | 82% |
| Wppa-All Plans | $3,433 | 86% |
| Midlands Choice-All Plans | $3,470 | 87% |
| UnitedHealthcare | $3,470 | 87% |
| Health Partners Of Ks Ppo-All Plans | $3,470 | 87% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Smith County Memorial Hospital in Smith Center, KS, the cash median price is $3,653.00, which matches the facility's gross charge. This cash rate is notably lower than the negotiated rates paid by most major payers, including Medicaid/KanCare, Multiplan, and UnitedHealthcare, which range from $3,287 to $3,653 depending on the specific plan. While the cash price is higher than the median negotiated rate of $3,433.00, patients with high-deductible plans may find paying out-of-pocket upfront more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash price. It is important to note that the facility is a Critical Access Hospital with government-local ownership, and patients should explicitly request self-pay or prompt-pay discounts before scheduling to avoid being billed the full negotiated amount.
The facility's pricing is benchmarked against the Medicare rate of $4,000.24, showing a ratio of 0.9, indicating the cash price is slightly below the federal baseline. This suggests the facility is pricing competitively relative to the government's cost-based standard, which serves as an objective measure of true healthcare delivery costs. Although the data does not provide specific county or state average comparisons for this procedure, the facility's location in Smith County (ZIP 66967) and its status as a Critical Access Hospital are relevant factors in understanding regional pricing dynamics. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to