Breast lump removal
Facility: Morris County Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,393
- Cash Discount Price: $2,741
- vs. Medicare Baseline: 0.85x 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $1,171 | 29% |
| Blue Cross Blue Shield | $1,782 - $4,787 | 45% |
| UnitedHealthcare | $1,782 - $4,569 | 45% |
| Choice Care Mcr Adv-All Plans | $1,782 | 45% |
| Coventry Mcr | $1,782 | 45% |
| Va Ccn-All Plans | $1,782 | 45% |
| Cigna | $3,305 | 83% |
| Aetna | $4,094 | 102% |
| Coventry Comm-All Other Plans | $4,112 | 103% |
| Multiplan-All Plans | $4,112 | 103% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Morris County Hospital in Council Grove, KS, lists a gross charge of $4,569.00. The facility's cash median price is $2,741.00, while the median negotiated rate across payers is $3,393.00. It is important to note that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures; therefore, patients with high-deductible plans may find paying the cash price of $2,741.00 more cost-effective than relying on insurance, which could result in a higher allowed amount. Before scheduling, patients should explicitly request self-pay or prompt-pay discounts, which can range from 20% to 50% off the billed amount, to ensure they are receiving the lowest possible rate.
When evaluating the cost of this procedure, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster. The Medicare amount for this service is $4,000.24, and the facility's negotiated rate of $3,393.00 is approximately 85% of the Medicare rate, indicating a pricing structure that is below the typical commercial markup range. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should remain vigilant regarding billing practices. If an itemized bill is received, consumers should request a full line-by-line statement to identify any unbundled codes or services not rendered, as these are common sources of error that can significantly inflate the final bill.