Breast lump removal
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $473
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.12x 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 |
|---|---|---|
| UnitedHealthcare | $450 | 11% |
| Aetna | $468 | 12% |
| Medicaid / KanCare | $468 - $472 | 12% |
| Providrs Care | $627 | 16% |
| Tricare | $1,863 | 47% |
| Blue Cross Blue Shield | $4,487 - $4,723 | 112% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal, the negotiated rates for in-network payers at Ascension Via Christi Hospital Manhattan, Inc. range from $448 to $472, with a median negotiated amount of $473.00. These contracted rates are significantly higher than the cash median, which is not reported for this service, and the facility's median paid amount is also unavailable. While commercial insurance contracts cap charges to protect members, these negotiated fees often exceed what a patient might pay out-of-pocket if they qualify for self-pay or prompt-pay discounts. Patients should verify their specific plan's deductible status and ask the hospital directly about self-pay pricing or prompt-pay incentives before scheduling, as paying in full upfront can sometimes result in a lower total cost than the insurance allowed amount, particularly for those with high-deductible plans.
The facility's pricing is benchmarked against the Medicare rate of $4,000.24, which serves as the federal baseline for actual healthcare delivery costs. Although the commercial negotiated rates appear lower than the Medicare amount in this specific instance, it is important to note that commercial rates typically average between 200% and 300% of Medicare rates nationwide, with fair pricing generally defined as 120% to 150%. The data indicates a variance of 0.1 against the Medicare benchmark for this specific transaction. Additionally, the facility is located in Manhattan, KS (zip 66502), and is a voluntary non-profit acute care hospital. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, they should