CMS Price Transparency Data

Breast lump removal

Facility: UT of Texas Southwestern University Hospital - William P. Clements Jr.

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,468
Cash Discount Price: $1,581
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at UT of Texas Southwestern University Hospital - William P. Clements Jr. is $1,468. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,581. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.37x the Medicare baseline. Located in 6201 Harry Hines Blvd, Dallas, TX.

Cash / Self-Pay

$1,581

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,468

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: $1,581 (40%)

Insurance Median: $1,468 (37%)

Cash: $1,581 (40% of Medicare)

Ins. Median: $1,468 (37% 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
Molina	$338 - $4,021	8%
Parkland	$338 - $964	8%
UnitedHealthcare	$338 - $9,545	8%
Wellpoint	$338 - $4,021	8%
Aetna	$389 - $1,539	10%
Superior	$396 - $4,021	10%
Procare	$410 - $3,829	10%
Ambetter / Centene	$419	10%
Blue Cross Blue Shield	$431 - $13,385	11%
Humana	$431 - $3,982	11%
Healthfirst	$803 - $1,776	20%
Quiktrip	$923 - $1,991	23%
Coventry	$965 - $2,210	24%
Maestro Health/Fort Worth Firefighters	$1,142 - $1,690	29%
Rockwall County	$1,149 - $2,213	29%
United Options Nexus	$1,195 - $12,019	30%
Cigna	$1,228 - $2,328	31%
Phcs	$1,416 - $2,564	35%
Galaxy Health Network	$1,478 - $2,782	37%
Multiplan	$1,478 - $2,750	37%
Healthsmart	$2,140 - $2,624	53%

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 $1,581.
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 UT of Texas Southwestern University Hospital - William P. Clements Jr. 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.