CMS Price Transparency Data

Breast lump removal

Facility: Watsonville Community Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $6,132
Cash Discount Price: $3,590
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Watsonville Community Hospital is $6,132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,590. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.53x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.

Cash / Self-Pay

$3,590

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,132

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: $3,590 (90%)

Insurance Median: $6,132 (153%)

Cash: $3,590 (90% of Medicare)

Ins. Median: $6,132 (153% 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
California Childrens Srvs	$302	8%
Ccs/Monterey County	$302	8%
Healthy Families	$302	8%
Medi-Cal E.R.	$302	8%
Medi-Cal/Eds	$302	8%
Medicaid / KanCare	$302	8%
Well Path	$302	8%
Alliance/Sccho	$390 - $411	10%
Aetna	$6,132	153%
Blue Cross Blue Shield	$7,070	177%
Calif Ironworkers Field	$7,070	177%
Carpenters H&W Trust	$7,070	177%
City Of Wats/Pinnacle Clm	$7,070	177%
Claims Management Wc	$7,070	177%
Delta Health Systems	$7,070	177%
Laborers Health & Welfare	$7,070	177%
Monterey Bay Pub Emp Trst	$7,070	177%
Operating Engineers	$7,070	177%
Pinnacle Claims Tpa/Bc	$7,070	177%
Robert Kennedy/Ccn	$7,070	177%
Sheet Metal Workers	$7,070	177%
State Compensation Fund	$7,070	177%
Teamsters Benefit Trust	$7,070	177%
Western Growers Trust/Bc	$7,070	177%

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 $3,590.
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 Watsonville Community 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.