CMS Price Transparency Data

Breast lump removal

Facility: The Children's Mercy Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,093
Cash Discount Price: $894
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at The Children's Mercy Hospital is $1,093. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $894. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.27x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$894

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,093

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4,000.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4,000.24 (100%)

Cash / Self-Pay: $894 (22%)

Insurance Median: $1,093 (27%)

Cash: $894 (22% of Medicare)

Ins. Median: $1,093 (27% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$374 - $9,463	9%
Healthy Blue	$399 - $9,463	10%
Medicaid / KanCare	$402 - $1,445	10%
Home State Health	$493 - $8,315	12%
Quiktrip	$497 - $3,233	12%
Healthlink	$510 - $4,370	13%
Health Midwest Comprehensive Care	$558 - $3,233	14%
Blue Cross Blue Shield	$562 - $3,675	14%
American Healthcare Alliance	$597 - $4,221	15%
Wppa Providrs Care	$606 - $3,228	15%
Multiplan	$631 - $3,774	16%
Aetna	$634 - $3,377	16%
Medica	$724 - $2,895	18%
Humana	$763 - $3,302	19%
Cigna	$766 - $3,451	19%
Orscheln	$771 - $3,228	19%
Wellfit/Centrus	$771 - $3,228	19%
Nebraska Furniture Mart	$787 - $3,228	20%
Centivo	$794 - $3,228	20%
Coventry Health Care Of Kansas	$801 - $3,675	20%
Mercy Health	$907 - $3,724	23%
Coxhealth Network	$919 - $3,675	23%
National Preferred Provider Network	$1,093 - $4,469	27%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $894.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 19120.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The Children's Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 19120.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.