Breast lump removal
Facility: Ascension Via Christi Rehabilitation Hospital Inc
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $866
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.22x 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 |
|---|---|---|
| Early Detection Works | $393 | 10% |
| Aetna | $1,339 | 33% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," at Ascension Via Christi Rehabilitation Hospital Inc in Wichita, KS, the facility's negotiated rates with major payers like Aetna and Early Detection Works are significantly lower than the Medicare benchmark of $4,000.24. While the data indicates a median negotiated payment of $866.00, this figure represents the amount insurers agreed to pay under contract rather than the final out-of-pocket cost for a patient. It is important to note that cash-pay rates are not listed for this specific service, meaning patients with high-deductible plans or those without insurance may not find a lower price by paying directly at the time of service. However, patients should always inquire about "self-pay" or "prompt-pay" discounts before scheduling, as hospitals often offer fee reductions for upfront payments that bypass the administrative costs and delays associated with insurance billing cycles.
The pricing structure for this procedure reflects standard commercial insurance dynamics where negotiated rates serve as a ceiling to protect in-network members, even though these rates often exceed the theoretical cost of care. Since the facility is a Part A provider in Kansas, the absence of a cash median suggests that the primary financial interaction will be through insurance networks rather than direct patient payment. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to verify that all ancillary services, such as specific lab tests or emergency physician visits, are also covered under the facility's network agreements. To ensure transparency and avoid unexpected charges, patients are encouraged to request a full itemized bill before finalizing payment, allowing them to review every line item and