Breast lump removal
Facility: Regional Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $870
- Cash Discount Price: $1,323
- vs. Medicare Baseline: 0.22x 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 22% |
Consumer Guidance & Cost Commentary
For patients paying out-of-pocket, the most important factor to know upfront is that the cash price for this procedure is $1,323, which is significantly lower than the facility's gross charge of $1,654. Because hospitals often offer prompt-pay discounts for upfront payment, self-pay patients should explicitly ask the billing department to classify the visit as self-pay before check-in to avoid automatic insurance claims that could void these savings. This cash rate may be more advantageous than the negotiated rate of $870, which is paid by Medical Associates Health Plan - Tri, particularly if a patient has a high-deductible plan where the insurance allowed amount exceeds the cash price, or if the patient has already met their deductible.
In the broader context of pricing, this facility is a Government - Local Critical Access Hospital in Manchester, Iowa, and the cash rate of $1,323 compares directly to the state and county averages provided in the data. While the facility's facility rating is 4 out of 5, it is essential to remember that in-network status does not guarantee the lowest possible price, as commercial negotiated rates often include administrative overhead that inflates the cost above the cash-pay option. To ensure you are receiving the best financial terms, always request an itemized billing audit if you receive a summary bill, as over 80% of hospital bills contain errors that can be corrected. Finally, while Medicare allows a benchmarking rate of $4,000.24 for this service, commercial rates are typically higher, so comparing your specific plan's negotiated rate of $870 against the cash price of $1,323 is the most effective way to determine your personal savings.