CMS Price Transparency Data

Breast lump removal

Facility: HCA Florida Palms West Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $10,472
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.62x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at HCA Florida Palms West Hospital is $10,472. 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 2.62x the Medicare baseline. Located in 13001 Southern Blvd, Loxahatchee, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,472

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: $10,472 (262%)

Ins. Median: $10,472 (262% 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 262% of the Medicare baseline (a markup of 162%). 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
Freedom Health	$2,350	59%
Optimum	$2,350	59%
Simply Healthcare Plans	$3,792	95%
Aids Healthcare	$3,950	99%
Molina	$3,950 - $5,211	99%
Health Sun Health Plan	$4,200	105%
Corvel Corporation	$4,311	108%
Careworks (Rockport)	$4,402	110%
Prime Health	$4,402	110%
Medica Healthcare	$4,500	112%
Mmm Of Fl (Health Advantage Plan)	$4,750	119%
Sunshine State Health Plan	$4,963	124%
Simply Healthcare	$5,360	134%
Oscar	$5,933	148%
Cigna	$6,802 - $11,754	170%
United	$7,029	176%
Aetna	$9,382 - $13,140	235%
Avmed	$9,796 - $20,955	245%
Amerihealth Caritas	$10,472	262%
Blue Cross Blue Shield	$13,571 - $18,507	339%
Humana	$16,049 - $17,832	401%

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 Palms West 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.