CMS Price Transparency Data

Breast lump removal

Facility: Baylor Scott & White Medical Center Hillcrest

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,484
Cash Discount Price: $5,580
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Baylor Scott & White Medical Center Hillcrest is $4,484. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,580. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.12x the Medicare baseline. Located in 100 Hillcrest Medical Blvd, Waco, TX.

Cash / Self-Pay

$5,580

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,484

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: $5,580 (139%)

Insurance Median: $4,484 (112%)

Cash: $5,580 (139% of Medicare)

Ins. Median: $4,484 (112% 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
Blue Cross Blue Shield	$66 - $5,453	2%
Superior Health Plan	$964	24%
Texas Workforce Commission	$3,069	77%
Baylor Scott & White Health Plan	$3,313 - $5,754	83%
Humana	$3,487 - $6,510	87%
Triwest	$3,487	87%
Corvel	$3,653	91%
Prime Health Services	$3,653	91%
American Health Plan	$3,662	92%
Procare Advantage	$3,662	92%
UnitedHealthcare	$4,010 - $4,881	100%
Injury Management Organization	$4,331	108%
Cigna	$4,463 - $5,608	112%
Midcoast	$5,115	128%
Quiktrip	$5,115	128%
Sedgwick	$5,214	130%
Healthsmart	$5,290 - $6,975	132%
University Of Mary Hardin-Baylor	$5,394	135%
Independent Medical System	$5,580	139%
Imagine Health	$5,826	146%
Curative	$6,045	151%
First Health	$6,510	163%
Private Health Care System	$6,975	174%
Aetna	$8,360	209%

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 $5,580.
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 Baylor Scott & White Medical Center Hillcrest 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.