CMS Price Transparency Data

Breast lump removal

Facility: HCA Florida Orange Park Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $11,859
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at HCA Florida Orange Park Hospital is $11,859. 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 2.96x the Medicare baseline. Located in 2001 Kingsley Ave, Orange Park, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,859

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: $11,859 (296%)

Ins. Median: $11,859 (296% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 296% of the Medicare baseline (a markup of 196%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Optimum Healthcare	$1,950	49%
Positive Healthcare	$3,950	99%
Simply Healthcare	$3,950 - $5,199	99%
Corvel Corporation	$4,106	103%
Prime Health	$4,192	105%
Medicare (plans)	$4,500	112%
Molina Healthcare	$5,211	130%
Sunshine State Health Plan	$6,673	167%
United	$6,776	169%
Aetna	$7,542 - $9,205	189%
Oscar	$8,023	201%
Avmed	$11,859 - $28,717	296%
Cigna	$12,484 - $16,483	312%
Blue Cross Blue Shield	$16,132 - $42,938	403%
Humana	$36,694	917%

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 HCA Florida Orange Park 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.