CMS Price Transparency Data

Breast lump removal

Facility: The Heart Hospital Baylor Denton

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,634
Cash Discount Price: $4,921
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at The Heart Hospital Baylor Denton is $4,634. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,921. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.16x the Medicare baseline. Located in 2801 South Mayhill Road, Denton, TX.

Cash / Self-Pay

$4,921

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,634

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: $4,921 (123%)

Insurance Median: $4,634 (116%)

Cash: $4,921 (123% of Medicare)

Ins. Median: $4,634 (116% 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
Superior Health Plan	$964 - $3,672	24%
Blue Cross Blue Shield	$2,871 - $6,397	72%
Baylor Scott & White Health Plan	$3,322 - $5,770	83%
Humana	$3,497 - $5,741	87%
Triwest	$3,497	87%
Corvel	$3,664	92%
Prime Health Services	$3,664	92%
American Health Plan	$3,672	92%
Healthspring	$3,672	92%
Procare Advantage	$3,672	92%
UnitedHealthcare	$4,022 - $5,667	101%
Cigna	$4,043 - $4,757	101%
Employers Health Network	$4,511	113%
Quiktrip	$4,511	113%
University Of Mary Hardin-Baylor	$4,757	119%
Imagine Health	$5,137	128%
Healthsmart	$5,290 - $6,151	132%
Curative	$5,331	133%
First Health	$5,741	144%
Private Health Care System	$6,151	154%
Ambetter / Centene	$7,239	181%
Aetna	$13,028	326%

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 $4,921.
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 The Heart Hospital Baylor Denton 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.