CMS Price Transparency Data

Breast lump removal

Facility: Santa Rosa Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $4,089
  • Cash Discount Price: $5,442
  • vs. Medicare Baseline: 1.02x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Santa Rosa Medical Center is $4,089. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,442. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.02x the Medicare baseline. Located in 6002 Berryhill Rd, Milton, FL.
Cash / Self-Pay
$5,442

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,089

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: $5,442 (136%)
Insurance Median: $4,089 (102%)
Cash: $5,442 (136% of Medicare)
Ins. Median: $4,089 (102% 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.

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
Veterans Eval Services $516 13%
Medicaid / KanCare $860 - $997 21%
Humana $885 - $4,023 22%
Wellcare $903 23%
Molina $971 24%
Fl Community Care $989 25%
Tricare $3,884 97%
Aetna $4,023 - $20,353 101%
Blue Cross Blue Shield $4,023 - $26,302 101%
Cigna $4,023 - $8,199 101%
Medicare (plans) $4,023 101%
UnitedHealthcare $4,023 - $7,038 101%
Prime Health Work Comp Fl $4,030 101%
Node Champva $4,089 102%
Node Va $4,089 102%
Florida Workers Compensation $4,154 104%
Node Wellcare Mcr Adv $4,225 106%
Geo Group $5,111 128%
Node Us Dept Of Labor $5,111 128%
Florida State Auto Insurance $8,178 204%
Self Pay $8,344 209%
Ambetter / Centene $9,772 244%
Oscar $12,324 308%
Hospice Of Nw Fl $18,140 453%
Prime Health Services $29,024 726%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 6002 Berryhill Rd, Milton, FL 32570
  • CMS Rating: ★★★★☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals