CMS Price Transparency Data

Breast lump removal

Facility: Kona Community Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,625
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Kona Community Hospital is $4,625. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.16x the Medicare baseline. Located in 79-1019 Haukapila Street, Kealakekua, HI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,625

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%)

Insurance Median: $4,625 (116%)

Ins. Median: $4,625 (116% 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	$456 - $4,772	11%
Hmsa	$479 - $5,830	12%
Hawaii Medical Service Association	$695 - $6,183	17%
Kaiser Permanente	$2,837 - $4,625	71%
Kaiser	$2,837 - $4,772	71%
Hma	$3,441	86%
Alohacare	$4,625 - $4,772	116%
Ohana Health Plan	$4,625 - $5,088	116%
Humana	$4,625 - $4,772	116%
Hmaa	$4,664	117%
Ohana	$4,772 - $5,249	119%
Devoted Health	$5,088	127%
Uha	$5,529	138%
University Health Alliance	$6,743	169%

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 $X.
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 Kona Community 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.