CMS Price Transparency Data

Breast lump removal

Facility: St David's South Austin Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,370
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at St David's South Austin Medical Center is $4,370. 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 1.09x the Medicare baseline. Located in 901 West Ben White Blvd, Austin, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,370

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: $4,370 (109%)

Ins. Median: $4,370 (109% 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
Amerigroup	$235	6%
St David’S Hospice	$964	24%
Blue Cross Blue Shield	$1,012 - $7,847	25%
United	$1,034 - $10,285	26%
Molina Healthcare	$1,060	26%
Humana	$1,205	30%
Sendero	$1,205	30%
Aetna	$1,349 - $5,457	34%
Superior Health Plan	$2,323	58%
Evry Health	$3,270	82%
Cigna	$3,716 - $4,744	93%
Nomi Health	$4,152 - $4,370	104%
Curative Administrators	$4,807	120%
Moda	$4,836	121%
Oscar	$5,014 - $5,926	125%
Healthcare Highways	$5,414 - $5,524	135%
Harbor Health Team	$5,675	142%
Moda Health	$5,927 - $6,046	148%

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 St David's South Austin Medical Center 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.