CMS Price Transparency Data

Breast lump removal

Facility: Baptist Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,959
Cash Discount Price: $541
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Baptist Hospital is $2,959. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $541. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.74x the Medicare baseline. Located in 123 Baptist Way, Pensacola, FL.

Cash / Self-Pay

$541

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,959

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%)

Cash / Self-Pay: $541 (14%)

Insurance Median: $2,959 (74%)

Cash: $541 (14% of Medicare)

Ins. Median: $2,959 (74% 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
Pensacola	$541	14%
Aetna	$852 - $4,036	21%
Cha Health Plan	$852	21%
UnitedHealthcare	$852 - $3,863	21%
Humana	$894 - $3,608	22%
Mh Sunshine Mcaid	$894	22%
Staywell	$894	22%
Sunshine Health	$894	22%
Fl Community Care Ltc	$911	23%
Simply Healthcare Healthy Kids	$979	24%
Hospice Regency	$1,082	27%
Cigna	$1,714 - $3,608	43%
Hospice Emerald Coast	$1,804	45%
Escambia	$2,165	54%
Private Healthcare	$2,345	59%
Uwf Athletes	$2,345	59%
First Health	$2,508	63%
Wc Corvel	$2,571 - $3,428	64%
Choicecare	$2,706	68%
Mh Choicecare	$2,706	68%
Multiplan	$3,211	80%
Mh Wellcare	$3,608	90%
Hospice Covenant	$3,844	96%
Medicare (plans)	$3,844	96%
Healthspring Of Fl Al	$3,959	99%
Wellcare	$4,036	101%
Fl Blue	$5,766 - $11,749	144%
Bc Fl	$8,509	213%

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 $541.
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 Baptist 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.