Breast lump removal
Facility: Lindsborg Community Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,504
- Cash Discount Price: $2,681
- vs. Medicare Baseline: 0.88x 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 |
|---|---|---|
| Tricare | $1,800 | 45% |
| Coventry Mcr Adv | $1,818 | 45% |
| Cigna | $3,256 | 81% |
| UnitedHealthcare | $3,447 | 86% |
| Coventry Comm-All Other Plans | $3,447 | 86% |
| Phcs Preferred-All Plans | $3,562 | 89% |
| Multiplan-All Plans | $3,562 | 89% |
| Health Partners -All Plans | $3,638 | 91% |
| Coventry Wc | $3,638 | 91% |
| Wppa-All Plans | $3,638 | 91% |
| Century Health-All Plans | $3,638 | 91% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal, Lindsborg Community Hospital in Kansas has a gross charge of $3,830.00. The facility's cash median rate is $2,681.00, while the median negotiated rate paid by insurance payers is $3,562.00. It is important to note that for patients with high-deductible plans, paying the cash price of $2,681.00 upfront can be more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price due to administrative overhead and contract structures. Additionally, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed by paying in full before or shortly after the service.
When evaluating this price against federal benchmarks, the Medicare amount for this procedure is $4,000.24. The facility's cash rate of $2,681.00 is lower than the Medicare benchmark, whereas the median negotiated rate of $3,562.00 is approximately 89% of the Medicare amount. This comparison highlights that while commercial negotiated rates are generally higher than the true cost baseline established by Medicare, the cash option here remains below the federal standard. Patients are advised to request an itemized billing audit to ensure no errors exist, as over 80% of hospital bills contain discrepancies, and to avoid balance billing by confirming their network status and understanding their deductible obligations before scheduling care.