CMS Price Transparency Data

Breast lump removal

Facility: Baylor Scott & White Medical Center - Marble Falls

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,499
Cash Discount Price: $5,580
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Baylor Scott & White Medical Center - Marble Falls is $4,499. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,580. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.12x the Medicare baseline. Located in 810 W Highway 71, Marble Falls, TX.

Cash / Self-Pay

$5,580

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,499

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: $5,580 (139%)

Insurance Median: $4,499 (112%)

Cash: $5,580 (139% of Medicare)

Ins. Median: $4,499 (112% 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
Blue Cross Blue Shield	$66 - $5,453	2%
Superior Health Plan	$964 - $3,361	24%
Baylor Scott & White Health Plan	$3,193 - $5,546	80%
UnitedHealthcare	$3,245 - $4,585	81%
Humana	$3,361 - $6,510	84%
Triwest	$3,361	84%
Corvel	$3,521	88%
Prime Health Services	$3,521	88%
American Health Plan	$3,529	88%
Healthspring	$3,529	88%
Procare Advantage	$3,529	88%
Cigna	$4,463 - $5,608	112%
Sedgwick	$5,025	126%
Midcoast	$5,115	128%
Quiktrip	$5,115	128%
Healthsmart	$5,290 - $6,975	132%
University Of Mary Hardin-Baylor	$5,394	135%
Independent Medical System	$5,580	139%
Curative	$6,045	151%
First Health	$6,510	163%
Bluebell Creameries	$6,975	174%
Private Health Care System	$6,975	174%
Aetna	$8,360	209%
Three Rivers	$8,371	209%

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 $5,580.
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 Baylor Scott & White Medical Center - Marble Falls 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.