CMS Price Transparency Data

Breast lump removal

Facility: Texas Orthopedic Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,399
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Texas Orthopedic Hospital is $3,399. 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 0.85x the Medicare baseline. Located in 7401 South Main Street, Houston, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,399

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: $3,399 (85%)

Ins. Median: $3,399 (85% 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
Texas Health Network	$944	24%
Amerigroup	$1,012	25%
United	$1,034 - $7,200	26%
Molina Healthcare	$1,060	26%
Community Health Choice Mcd	$1,079	27%
Humana	$1,205 - $4,690	30%
Aetna	$1,217 - $5,025	30%
Fidelis Securecare Of Tx	$2,115	53%
Superior Health Plan	$2,369	59%
Healthcare Highways	$3,041	76%
Wellmed	$3,953	99%
Evry Health	$4,052	101%
Curative Administrators	$4,807	120%
Blue Cross Blue Shield	$5,393 - $8,271	135%
Oscar	$5,571	139%
Cigna	$9,751 - $12,562	244%

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 Texas Orthopedic 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.