Breast lump removal
Facility: Bob Wilson Memorial Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $5,530
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.38x 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 |
|---|---|---|
| Blue Cross Blue Shield | $5,530 | 138% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Bob Wilson Memorial Hospital in Ulysses, Kansas, the facility's negotiated rate is $5,530. This amount aligns exactly with the lowest and highest negotiated rates reported for this procedure in the region, as there is only one payer plan available. When compared to the Medicare benchmark of $4,000.24, the commercial negotiated rate is 1.4 times higher, reflecting the standard markup often seen in commercial contracts. While cash payments are not listed for this specific service, patients should be aware that paying out-of-pocket can sometimes result in lower costs if the insurance negotiated rate exceeds the cash price, particularly for those with high-deductible plans. It is always advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can significantly reduce the final amount owed.
The facility operates as a voluntary non-profit church-owned Critical Access Hospital in the 67880 zip code. Because the data indicates only a single payer with a uniform rate, there are no variations in pricing across different insurance plans to compare against state or county averages. However, the relationship between the Medicare rate and the negotiated amount highlights the importance of understanding the true cost baseline rather than relying on the hospital's full chargemaster list. To ensure you are receiving fair pricing, patients should request an itemized bill to verify that all charges are accurate and that no services have been unbundled or double-billed. If you have questions about your specific deductible status or plan coverage, checking with your insurance provider before scheduling is the most effective way to avoid unexpected financial burdens.