CMS Price Transparency Data

Breast lump removal

Facility: Tops Surgical Specialty Hospital

Billing Code: 19120 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$3,702

about 0.9× the $4,000 Medicare rate · typically $2,024–$4,363

modeled estimate · not a bill or quote

What this hospital charges insurers

$2,369

Below the fair price — a good deal

about $1,333 under the fair price · 0.6× Medicare

Medicare pays $4,000 Fair price $3,702 This hospital $2,369 Cash price $1,343 Hospital's list price $3,838

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

Highest price of the 9 TX hospitals we have prices for — worth calling around.

Cheapest $458 Priciest $2,369

Black dot = this hospital, among the 9 TX hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $3,702 (about 0.9× the $4,000 Medicare rate). Tops Surgical Specialty Hospital charges insurers about $2,369, or about $1,343 in cash — below the fair price — a good deal. Located in Houston, TX.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$880 - $5,747	22%
Blue Cross Blue Shieldmajor	$1,727 - $2,034	43%
Aetnamajor	$1,501 - $4,340	38%
Cignamajor	$4,595 - $5,394	115%
Humanamajor	$1,858 - $3,058	46%
Ambetter (Centene)	$607 - $2,827	15%
Health Net	$868 - $3,262	22%
Oscar Health	$530 - $3,016	13%

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,343), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Tops Surgical Specialty Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Tops Surgical Specialty Hospital

Compare: Breast lump removal at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.