Breast lump removal
Facility: Liberty Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $4,764
- Cash Discount Price: $2,400
- vs. Medicare Baseline: 1.19x 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 | $309 - $16,610 | 8% |
| Cigna | $839 - $3,383 | 21% |
| Aetna | $3,383 - $4,764 | 85% |
| UnitedHealthcare | $3,383 - $5,582 | 85% |
| Medicare (plans) | $3,417 - $3,721 | 85% |
| Humana | $3,451 - $5,150 | 86% |
| Healthy Blue | $3,630 | 91% |
| Ambetter / Centene | $4,296 | 107% |
| Home State Health | $4,964 | 124% |
| Fox Everett | $5,105 | 128% |
| Phcs | $6,381 | 160% |
| Multiplan | $7,062 | 177% |
Consumer Guidance & Cost Commentary
For this procedure, Liberty Hospital's cash price of $2,400 is significantly lower than the facility's gross charge of $8,508, representing a substantial discount for patients paying out-of-pocket. The cash rate is also notably lower than the Medicare benchmark of $4,000.24, which serves as the federal baseline for evaluating hospital pricing markups. While the facility's negotiated rates vary widely among payers—ranging from a low of $309 with Blue Cross Blue Shield to a high of $16,610 with the same carrier—the cash option remains the most affordable path for this specific service, particularly for those with high-deductible plans where insurance negotiated rates might exceed the self-pay amount.
Patients should verify whether they qualify for self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can further reduce costs by bypassing administrative fees and collection risks associated with insurance billing. It is important to note that while the median negotiated rate for Aetna is $4,764, commercial rates are often inflated by administrative structures and contract dynamics, making the direct cash price a more transparent comparison point. Since the No Surprises Act prohibits balance billing for emergency and non-emergency services at in-network facilities, patients can expect to pay only the agreed-upon cash or negotiated amount rather than the difference between the chargemaster and the insurer's allowed amount, provided they secure a waiver of insurance submission prior to treatment.