Breast lump removal
Facility: William Newton Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $368
- Cash Discount Price: $1,008
- vs. Medicare Baseline: 0.09x 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 |
|---|---|---|
| Triwest- All Plans | $349 | 9% |
| Ambetter / Centene | $356 - $423 | 9% |
| UnitedHealthcare | $368 | 9% |
| Blue Cross Blue Shield | $368 | 9% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at William Newton Hospital in Winfield, KS, the facility's cash median price is $1,008. This cash rate is significantly lower than the facility's negotiated rates, which range from $349 to $423 depending on the payer, such as Triwest, Ambetter/Centene, UnitedHealthcare, and Blue Cross Blue Shield. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should note that commercial insurance contracts often include administrative overheads that can inflate the final allowed amount. If you have a high-deductible plan, paying the cash price of $1,008 upfront may result in lower out-of-pocket costs compared to your insurance's negotiated rate, provided you have not yet met your deductible. It is always advisable to ask the billing department about self-pay or prompt-pay discounts before scheduling, as these can further reduce the total amount owed.
When evaluating the cost of this procedure, it is important 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 cash price is approximately 25% of that benchmark, indicating a substantial discount from the federal baseline. Although the data does not provide specific state or county average figures for comparison, the facility's location in Winfield (ZIP 67156) is relevant for understanding local cost variations. To ensure you are receiving fair pricing, patients should request an itemized bill to verify that no unbundled codes or services not rendered are included, as over 80% of