CMS Price Transparency Data

Breast lump removal

Facility: Nocona General Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $6,816
Cash Discount Price: $28
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Nocona General Hospital is $6,816. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.70x the Medicare baseline. Located in 100 Park Road, Nocona, TX.

Cash / Self-Pay

$28

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,816

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: $28 (1%)

Insurance Median: $6,816 (170%)

Cash: $28 (1% of Medicare)

Ins. Median: $6,816 (170% 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
United_Healthcare	$1,772	44%
Blue_Cross	$5,756 - $6,392	144%
Humana	$6,816	170%
Cigna	$7,270	182%
Phcs	$7,997	200%
Healthsmart	$8,179	204%

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 $28.
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 Nocona General 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.