CMS Price Transparency Data

Breast lump removal

Facility: Halifax Health Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,844
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Halifax Health Medical Center is $3,844. 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 0.96x the Medicare baseline. Located in 303 N Clyde Morris Blvd, Daytona Beach, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,844

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: $3,844 (96%)

Ins. Median: $3,844 (96% 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
Embs	$3,267	82%
Tricare	$3,509	88%
Humana	$3,728 - $7,649	93%
Aetna	$3,844 - $7,895	96%
Americas Choice Provider Network	$3,844	96%
Blue Cross Blue Shield	$3,844	96%
Cigna	$3,844	96%
Coventry	$3,844	96%
Division Of The Blind	$3,844	96%
Freedom Health	$3,844	96%
Medicare (plans)	$3,844	96%
Optimum Healthcare	$3,844	96%
Sunshine State Health Plan	$3,844 - $7,688	96%
UnitedHealthcare	$3,844	96%
Wellcare	$3,844	96%
Molina	$3,921	98%
Devoted Health	$3,998	100%
Independent Living Systems	$4,036	101%
Longevity	$4,036	101%
Prime Health Services	$4,036	101%
Clear Spring Health Of Fl	$4,190	105%
Evolutions	$5,766	144%
Employers Health Network	$7,688	192%
Fhcp	$7,764	194%
Centivo	$8,264	207%
Florida Healthcare	$8,341	209%
Claimdoc	$8,648	216%

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 Halifax Health Medical Center 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.