CMS Price Transparency Data

Breast lump removal

Facility: City of Hope National Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,520
Cash Discount Price: $5,651
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at City of Hope National Medical Center is $4,520. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,651. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.13x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$5,651

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,520

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: $5,651 (141%)

Insurance Median: $4,520 (113%)

Cash: $5,651 (141% of Medicare)

Ins. Median: $4,520 (113% 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
Health Net	$211 - $6,622	5%
Heritage Provider Network	$263 - $3,955	7%
Cal Optima	$295 - $440	7%
Inland Empire	$453 - $4,520	11%
Prime Healthcare Keenan	$770 - $5,424	19%
Blue Cross Blue Shield	$2,825 - $8,779	71%
UnitedHealthcare	$3,164 - $11,301	79%
Blue Shield	$3,345 - $6,735	84%
Blue Shield Covca	$3,718	93%
Blue Shield Promise	$3,955	99%
Cencal	$4,520	113%
La Care Health	$4,520	113%
Kaiser	$5,085	127%
Gold Coast	$5,650	141%
Molina	$5,650 - $7,346	141%
Cigna	$6,069	152%
Aetna	$6,216	155%
Healthcare Partners	$6,555	164%
St. Joseph Heritage	$6,781	170%
Primecare Medical Network	$7,346	184%
First Health	$8,702	218%
Phcs Multiplan	$10,171	254%

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 $5,651.
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 City of Hope National 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.