CMS Price Transparency Data

Breast lump removal

Facility: Madison St Joseph Health Center

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,241

about 0.3× the $4,000 Medicare rate · typically $432–$2,746

modeled estimate · not a bill or quote

What this hospital charges insurers

$465

Below the fair price — a good deal

about $776 under the fair price · 0.1× Medicare

Medicare pays $4,000 Fair price $1,241 This hospital $465 Cash price $123 Hospital's list price $704

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

One of the lower prices — 7 of 8 other TX hospitals charge more for the same procedure.

Cheapest $458 Priciest $912

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 $1,241 (about 0.3× the $4,000 Medicare rate). Madison St Joseph Health Center charges insurers about $465, or about $123 in cash — below the fair price — a good deal. Located in Madisonville, 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	$93 - $8,788	2%
Blue Cross Blue Shieldmajor	$92 - $4,999	2%
Aetnamajor	$92 - $465	2%
Cignamajor	$451 - $3,711	11%
Humanamajor	$429	11%
Ambetter (Centene)	$133	3%
Bright Health	$263	7%
+ 7 smaller / regional plans	$94 - $2,514

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 123), 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 Madison St Joseph Health Center 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 Madison St Joseph Health Center

Compare: Breast lump removal at other TX hospitals

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