CMS Price Transparency Data

Breast lump removal

Facility: Santa Monica - UCLA Med Ctr & Orthopaedic Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $5,352
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Santa Monica - UCLA Med Ctr & Orthopaedic Hospital is $5,352. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.34x the Medicare baseline. Located in 1250 16Th Street, Santa Monica, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,352

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%)

Insurance Median: $5,352 (134%)

Ins. Median: $5,352 (134% 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	$4,865 - $7,998	122%
La Care Dsnp	$4,865	122%
Monarch	$4,865	122%
UnitedHealthcare	$4,865 - $14,453	122%
Aetna	$5,036	126%
Medicare (plans)	$5,036 - $5,352	126%
St. Jude	$5,036	126%
Triwest Healthcare Alliance	$5,036	126%
Blue Cross Blue Shield	$5,301 - $5,949	133%
Providence Healthcare	$5,352	134%
Central Health Plan	$5,715	143%
Healthsmart	$6,043	151%
Scan	$6,568	164%
La Care Covered Ca	$6,668	167%
Centivo	$12,086	302%
Health Plan Of Nevada Commercial	$14,028	351%

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 $X.
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 Santa Monica - UCLA Med Ctr & Orthopaedic 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.