CMS Price Transparency Data

Breast lump removal

Facility: Saint Agnes Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $5,754
Cash Discount Price: $19,185
vs. Medicare Baseline: 1.44x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Saint Agnes Medical Center is $5,754. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,185. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.44x the Medicare baseline. Located in 1303 E Herndon Ave, Fresno, CA.

Cash / Self-Pay

$19,185

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,754

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: $19,185 (480%)

Insurance Median: $5,754 (144%)

Cash: $19,185 (480% of Medicare)

Ins. Median: $5,754 (144% 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
Medi-Cal Healthnet	$81 - $7,212	2%
Correctcare Integrated Health	$1,118	28%
Blue Cross Blue Shield	$2,622 - $10,442	66%
Blue Shield - Ca	$4,014 - $5,754	100%
Aetna	$4,935	123%
Humana	$4,935 - $5,187	123%
UnitedHealthcare	$5,034 - $7,029	126%
Medicare (plans)	$5,141 - $5,187	129%
Welbe Health	$5,182	130%
Blue Benefit Administrators Of Massachusetts	$5,754	144%
Blue Care Network	$5,754	144%
Blue Distinction Transplant	$5,754	144%
Blue Shield - Id (Regence)	$5,754	144%
Blue Shield - Ny Highmark Northeastern	$5,754	144%
Blue Shield - Ny Highmark Western	$5,754	144%
Blue Shield - Pa (Highmark)	$5,754	144%
Blue Shield - Wa (Regence)	$5,754	144%
Align Senior Care	$5,791	145%
Geha	$7,029	176%
Kaiser Permanente	$8,813	220%
Advantek Central Usd	$10,442	261%
Healthnet	$10,451	261%

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 $19,185.
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 Saint Agnes Medical Center 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.