CMS Price Transparency Data

Breast lump removal

Facility: Adventist Health Ukiah Valley

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,726
Cash Discount Price: $431
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Adventist Health Ukiah Valley is $1,726. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $431. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.43x the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$431

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,726

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: $431 (11%)

Insurance Median: $1,726 (43%)

Cash: $431 (11% of Medicare)

Ins. Median: $1,726 (43% 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 Cross Blue Shield	$66 - $11,339	2%
Kaiser Medi-Cal	$211	5%
Medi-Cal	$211	5%
Blue Shield Mcr Adv	$280 - $5,393	7%
Kaiser Mcr Adv	$280 - $5,393	7%
Tricare	$280 - $5,393	7%
Aetna	$323 - $7,164	8%
Ah Employee Health Plan - All Plans	$445 - $9,708	11%
Cigna	$504 - $13,283	13%
UnitedHealthcare	$526 - $14,235	13%
Blue Shield Epn-All Other Plans	$572 - $7,616	14%
Western Growers-All Plans	$579 - $19,507	14%
Healthnet-All Plans	$590 - $9,741	15%
Blue Shield Non-Epn	$604 - $7,834	15%
Mendocino Lcc District-All Plans	$935 - $3,500	23%
Kaiser-All Other Plans	$1,150 - $13,623	29%
Three Rivers-All Plans	$1,294 - $15,326	32%
Foundation For Medical Care-All Plans	$1,359 - $12,772	34%
Networks By Design-All Plans	$1,450 - $13,623	36%
Phcs Multiplan-All Plans	$1,450 - $13,623	36%
Interplan-All Plans	$1,486 - $13,964	37%
Beech Street-All Plans	$1,540 - $14,475	38%
Choice Care-All Plans	$1,540 - $14,475	38%
Health Mgmt Network-All Plans	$1,540 - $14,475	38%

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 $431.
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 Adventist Health Ukiah Valley 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.