CMS Price Transparency Data

Breast lump removal

Facility: Memorial Hospital West

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,526
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Memorial Hospital West is $4,526. 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 1.13x the Medicare baseline. Located in 703 N Flamingo Rd, Pembroke Pines, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,526

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: $4,526 (113%)

Ins. Median: $4,526 (113% 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
Broward County	$718	18%
UnitedHealthcare	$4,089 - $4,907	102%
Health Value Management	$4,211	105%
Wellcare	$4,334 - $4,457	108%
Florida Community Care	$4,375	109%
Humana	$4,416	110%
Corvel	$4,514	113%
Employers Choice Network	$4,514	113%
First Health	$4,514	113%
Gallagher Bassett	$4,514	113%
Prime Health Services	$4,514	113%
Aetna	$4,539	113%
Doctors Healthcare Plans	$4,620	115%
Solis Health Plan	$4,620	115%
Health Sun	$4,661	117%
Florida Pace Centers	$4,702	118%
Align Senior Care	$4,988	125%
Gold Kidney	$4,988	125%
Longevity	$5,111	128%
Sunshine	$5,520 - $7,769	138%

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 Memorial Hospital West 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.