CMS Price Transparency Data

Breast lump removal

Facility: Saint John's Health Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $6,484
Cash Discount Price: $3,584
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Saint John's Health Center is $6,484. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,584. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.62x the Medicare baseline. Located in 2121 Santa Monica Blvd, Santa Monica, CA.

Cash / Self-Pay

$3,584

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,484

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: $3,584 (90%)

Insurance Median: $6,484 (162%)

Cash: $3,584 (90% of Medicare)

Ins. Median: $6,484 (162% 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	$1,747 - $6,484	44%
Aetna	$5,036	126%
Humana	$5,137	128%
Blue Cross Blue Shield	$5,276 - $6,790	132%
Central Health Plan	$5,539	138%
UnitedHealthcare	$5,821 - $6,603	146%
La Care Health Plan	$6,547	164%
Healthnet	$7,332 - $11,827	183%
Cigna	$10,103	253%

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 $3,584.
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 John's Health 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.