Breast lump removal
Facility: Memorial Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $1,934
- Cash Discount Price: $1,108
- vs. Medicare Baseline: 0.48x 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 | $368 - $1,915 | 9% |
| Ambetter / Centene | $405 - $2,106 | 10% |
| Humana | $1,915 | 48% |
| Medicare (plans) | $1,934 | 48% |
| Coventry - All Other Plans | $3,447 | 86% |
| Health Partners Of Kansas - All Plans | $3,638 | 91% |
| Preferred Healthcare-All Plans | $3,638 | 91% |
| Wppa/Providers Care-All Plans | $5,362 | 134% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Memorial Hospital in Abilene, KS, the cash price is $1,108. This amount is significantly lower than the facility's gross charge of $1,108 (which appears to be the listed rate in this dataset) and notably lower than the negotiated rates paid by major payers such as Tricare ($368–$1,915), Ambetter/Centene ($405–$2,106), and Humana ($1,915). While the cash rate is the lowest figure available in this report, patients with high-deductible plans should verify if their specific insurance negotiated rate exceeds $1,108, as paying out-of-pocket might result in lower total costs if the deductible has not yet been met. It is crucial to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final amount owed.
The facility's pricing structure should be viewed through the lens of Medicare benchmarking, where the Medicare amount for this service is $4,000.24. Commercial negotiated rates often exceed Medicare benchmarks by a significant margin due to administrative overhead and contract dynamics, though in this specific dataset, the cash price is the most favorable option compared to the higher negotiated ceilings seen with providers like Coventry ($3,447) and WPPA/Providers Care ($5,362). Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, meaning unexpected bills for