Breast lump removal
Facility: Amberwell Atchison Association
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $441
- Cash Discount Price: $875
- vs. Medicare Baseline: 0.11x 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 |
|---|---|---|
| UnitedHealthcare | $356 - $436 | 9% |
| Superior Select Mcr Adv - All Plans | $368 | 9% |
| Va Ccn - All Plans | $368 | 9% |
| Humana | $368 - $493 | 9% |
| Triwest - All Plans | $368 | 9% |
| Centrus Health Direct - All Plans | $441 | 11% |
| Cigna | $448 | 11% |
| Aetna | $513 | 13% |
| Ambetter / Centene | $538 | 13% |
| Oscar - All Plans | $588 | 15% |
| Wppa Providrs Care - All Plans | $670 | 17% |
| Multiplan - All Plans | $699 | 17% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Amberwell Atchison Association in Atchison, KS, lists a cash price of $875.00, which matches the facility's cash median. This cash rate is significantly lower than the state average for this procedure, as the median negotiated rate across payers is $441.00, and the lowest negotiated rate found is $356.00. While commercial insurance plans like UnitedHealthcare and Humana negotiate rates ranging from $356 to $493, these amounts often exceed the cash price. Patients with high-deductible plans or those without insurance may find it financially advantageous to pay the $875.00 cash rate directly, as it avoids the administrative overhead and higher negotiated fees that insurers charge.
To ensure you are not overcharged, it is important to understand that commercial rates are often inflated by administrative costs and contract dynamics, whereas Medicare rates serve as a more objective benchmark for true cost. For this procedure, the Medicare amount is $4,000.24, which is notably higher than both the cash and negotiated rates, reflecting the specific payment structures for this service. If you choose to use insurance, be aware that balance billing could occur if you receive care from out-of-network providers, though the No Surprises Act protects you from such surprise bills for emergency and non-emergency services at in-network facilities. Finally, always ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can sometimes result in additional fee reductions beyond the standard cash price.