CMS Price Transparency Data

Breast lump removal

Facility: St Luke's Hospital at the Vintage

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,219
Cash Discount Price: $3,114
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at St Luke's Hospital at the Vintage is $4,219. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,114. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.05x the Medicare baseline. Located in 20171 Chasewood Park Drive, Houston, TX.

Cash / Self-Pay

$3,114

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,219

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: $3,114 (78%)

Insurance Median: $4,219 (105%)

Cash: $3,114 (78% of Medicare)

Ins. Median: $4,219 (105% 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
Tchp	$964 - $1,291	24%
Wellpoint	$964 - $5,753	24%
United	$983 - $5,145	25%
UnitedHealthcare	$983 - $7,352	25%
Blue Cross Blue Shield	$1,012 - $5,817	25%
Chc	$1,108 - $4,894	28%
Aetna	$1,233 - $6,762	31%
Kelseycare	$1,518 - $5,178	38%
Healthsmart	$1,609 - $6,229	40%
Independent Med System	$1,795	45%
Humana	$2,025 - $5,784	51%
Renaissance	$2,762	69%
Tchpchip	$3,114 - $3,826	78%
Cigna	$3,262 - $9,029	82%
Kelsey	$3,835	96%
Selectcare	$3,835	96%
Amerivantage	$3,951	99%
Devoted	$4,104	103%
Scanhealth	$4,104	103%
Kindred	$4,219	105%
Texastruechoice	$4,894	122%
PHCS	$5,252	131%
PHCS Savility	$5,252	131%
Bright Health	$5,281	132%
Employer Direct	$5,370	134%
Community Health Choice	$5,753	144%
Superior Health Plan	$5,753	144%
Coventry	$5,784	145%
First Health	$5,784	145%
Interlink	$6,229	156%
Multiplan	$6,674	167%
USA Health Network	$7,563	189%
Mhealth Network	$8,898	222%
Nx Health	$12,465	312%

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 $3,114.
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 St Luke's Hospital at the Vintage 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.