Breast lump removal
Facility: Salina Regional Health Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,447
- Cash Discount Price: $2,681
- vs. Medicare Baseline: 0.86x 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 |
|---|---|---|
| Preferred Phsic | $2,298 | 57% |
| Preferred Healthcare - All Other Plans | $3,102 | 78% |
| Multiplan (Mpi)-All Plans | $3,447 | 86% |
| Cigna | $3,447 | 86% |
| Providers Care (Wppa)-All Plans | $3,447 | 86% |
| Aetna | $3,447 | 86% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Salina Regional Health Center in Salina, KS, the facility's negotiated rates range from $2,298 to $3,447 depending on the insurance carrier. While the cash price is $2,681, commercial insurance contracts often result in higher out-of-pocket costs for patients who have not yet met their deductibles, as the median negotiated amount paid by insurers is $3,447. This aligns with the facility's median negotiated rate of $3,447, which is consistent across most major payers listed, including Preferred Phsic, Cigna, and Aetna. It is important to note that while in-network status provides protection against balance billing under the No Surprises Act, it does not guarantee the lowest possible price, as different insurers negotiate different ceilings with the same facility.
When evaluating costs against national standards, the facility's cash price of $2,681 is 69% of the Medicare benchmark amount of $4,000.24, suggesting a markup that is lower than the typical 200% to 300% range seen in commercial pricing. However, patients should be aware that commercial negotiated rates frequently exceed cash prices due to administrative overhead and contract structures. To potentially lower costs, patients with high-deductible plans should verify if paying cash upfront offers a better rate than their specific insurance plan's allowed amount. Additionally, requesting a prompt-pay discount or self-pay classification before scheduling can bypass insurance billing cycles and administrative fees, which often inflate the final bill by 20% to 40%.