CMS Price Transparency Data

Breast lump removal

Facility: Providence St. Joseph Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $8,172
Cash Discount Price: $6,503
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Providence St. Joseph Hospital is $8,172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,503. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 2.04x the Medicare baseline. Located in 1100 West Stewart Dr, Orange, CA.

Cash / Self-Pay

$6,503

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,172

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: $6,503 (163%)

Insurance Median: $8,172 (204%)

Cash: $6,503 (163% of Medicare)

Ins. Median: $8,172 (204% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 204% of the Medicare baseline (a markup of 104%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Providence	$4,281	107%
Aetna	$5,036 - $8,741	126%
Blue Cross Blue Shield	$5,276 - $14,208	132%
UnitedHealthcare	$5,463 - $5,978	137%
Blue Shield	$7,602 - $10,471	190%
Healthnet	$9,316 - $9,990	233%

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 $6,503.
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 Providence St. Joseph 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.