Breast lump removal
Facility: Neosho Memorial Regional Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $660
- Cash Discount Price: $597
- vs. Medicare Baseline: 0.16x 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 |
|---|---|---|
| Tricare | $245 | 6% |
| Medadv_Allwell | $579 | 14% |
| Va_Ccn | $579 | 14% |
| Blue Cross Blue Shield | $579 - $796 | 14% |
| Humana | $579 | 14% |
| Aetna | $579 | 14% |
| Medadv_Uhc | $579 | 14% |
| Medicare (plans) | $579 | 14% |
| Ambetter / Centene | $608 | 15% |
| Wppa_Providrscare | $660 | 16% |
| United | $662 | 17% |
| Hpk | $756 | 19% |
| Coventry | $756 | 19% |
| Cigna | $756 | 19% |
| Medicaid / KanCare | $796 | 20% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Neosho Memorial Regional Medical Center in Chanute, KS, the facility's cash median price is $597.00. This cash rate is notably lower than the gross chargemaster of $796.00 and sits below the negotiated rates paid by most major insurers, which range from $579 to $796 depending on the plan. While the facility is a Critical Access Hospital with government local ownership, patients with high-deductible plans may find that paying the cash price directly is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that while the facility offers a cash median of $597.00, the specific negotiated rate for Medicaid/KanCare plans is $796.00, which matches the gross charge, suggesting that for those specific beneficiaries, the cash rate represents a significant discount.
When evaluating the cost of this procedure, it is crucial to understand that commercial insurance rates are often inflated by administrative overhead and contract structures, sometimes reaching 200% to 300% of the Medicare benchmark rate of $400.24 for this service. Although the data does not provide a direct county or state average for comparison, the facility's cash price of $597.00 serves as a reliable baseline for patients who have exhausted their insurance benefits or possess high-deductible plans. To minimize out-of-pocket costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20