CMS Price Transparency Data

Breast lump removal

Facility: HCA Florida Northside Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $9,820
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at HCA Florida Northside Hospital is $9,820. 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 2.45x the Medicare baseline. Located in 6000 49Th St N, Saint Petersburg, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$9,820

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: $9,820 (245%)

Ins. Median: $9,820 (245% 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 245% of the Medicare baseline (a markup of 145%). 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
Suncoast Neighborly Care	$975	24%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$1,638	41%
Access 2 Healthcare Physicians Freedom Health	$1,950	49%
Access 2 Healthcare Physicians Optimum	$1,950	49%
Freedom Health Care	$1,950	49%
Optimum Healthcare	$1,950	49%
Molina	$3,950 - $5,711	99%
Simply Healthcare	$3,950 - $4,931	99%
Corvel Corporation	$4,168	104%
Rockport Healthcare Group	$4,168	104%
Prime Health	$4,256	106%
United	$5,675	142%
Sunshine State Health Plan	$6,769	169%
Oscar	$7,522	188%
Aetna	$9,081 - $13,982	227%
Blue Cross Blue Shield	$10,559 - $22,449	264%
Truli	$10,559 - $13,740	264%
Cigna	$11,502	288%
Avmed	$11,933 - $28,672	298%
Humana	$14,540	363%
Evolutions Healthcare Systems	$14,791	370%

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 Northside 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.