CMS Price Transparency Data

Breast lump removal

Facility: Antelope Valley Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $5,162
Cash Discount Price: $10,200
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Antelope Valley Hospital is $5,162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,200. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.29x the Medicare baseline. Located in 1600 W Ave J, Lancaster, CA.

Cash / Self-Pay

$10,200

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,162

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: $10,200 (255%)

Insurance Median: $5,162 (129%)

Cash: $10,200 (255% of Medicare)

Ins. Median: $5,162 (129% 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 Shield Of California	$550	14%
Aetna	$4,896	122%
Alignment Healthcare	$5,011	125%
Central Health Plan Of California	$5,011	125%
Citizens Choice Healthplan	$5,011	125%
Health Net Of California	$5,011 - $7,016	125%
L.A. Care Health Plan	$5,011	125%
Wellcare	$5,011	125%
Humana	$5,111	128%
For Your Benefit	$5,162	129%
Brand New Day	$5,262	132%
Blue Shield	$5,393 - $6,042	135%
Aids Foundation	$5,763	144%
Align Senior Care Ca	$5,763	144%
Champion Health Plan	$5,763	144%
Clever Care Health Plan	$6,013	150%
Ca State Prison	$6,515	163%
Oscar Hp/Providence Health Network	$7,517	188%

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 $10,200.
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 Antelope Valley Hospital 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.