CMS Price Transparency Data

Breast lump removal

Facility: Harlingen Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,914
Cash Discount Price: $3,914
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Harlingen Medical Center is $3,914. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,914. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.98x the Medicare baseline. Located in 5501 South Expressway 77, Harlingen, TX.

Cash / Self-Pay

$3,914

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,914

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: $3,914 (98%)

Insurance Median: $3,914 (98%)

Cash: $3,914 (98% of Medicare)

Ins. Median: $3,914 (98% 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
Aetna	$1,330 - $3,914	33%
Blue Cross Blue Shield	$3,908 - $4,332	98%
Careworks Worker Compensation Fka Rockport Community Network	$3,914	98%
Cigna	$3,914 - $4,031	98%
Humana	$3,914	98%
Medicare (plans)	$3,914	98%
San Benito Medical Associates	$3,914	98%
Superior Health Plan	$3,914	98%
Texas Bluebonnett Health Plan	$3,914 - $6,458	98%
Tricare	$3,914	98%
UnitedHealthcare	$3,914 - $4,100	98%
Veterans Evaluation Services	$3,914	98%
Wellmed	$3,914	98%
Workers Compensation	$3,914	98%
Molina	$4,110 - $6,067	103%
Provider Partners Health Plan	$4,110	103%
Imperial Insurance Company	$4,149	104%
Asserta Health	$5,088	127%
Friday Health Plan	$5,088	127%
Magic Valley Electric Cooperative	$5,088	127%
Superior Health Commercial Exchange	$5,088	127%
Employer Direct Healthcare	$5,480	137%
Corporate Remedies Worker Compensation	$5,871	147%
Naphcare	$6,067	152%
Baker Benefits Administrators	$7,828	196%

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 $3,914.
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 Harlingen 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.