CMS Price Transparency Data

Breast lump removal

Facility: Scripps Memorial Hospital La Jolla

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$5,207

about 1.3× the $4,000 Medicare rate · typically $1,980–$6,387

modeled estimate · not a bill or quote

What this hospital charges insurers

$5,036

About the fair price

about $171 under the fair price · 1.3× Medicare

Medicare pays $4,000 Fair price $5,207 This hospital $5,036 Cash price $4,987 Hospital's list price $19,947

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $445 Priciest $5,036

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $5,207 (about 1.3× the $4,000 Medicare rate). Scripps Memorial Hospital La Jolla charges insurers about $5,036, or about $4,987 in cash — about the fair price. Located in La Jolla, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$424 - $5,288	11%
Blue Cross Blue Shieldmajor	$2,390 - $5,036	60%
Aetnamajor	$424 - $5,036	11%
Cignamajor	$2,390 - $5,036	60%
Humanamajor	$5,036	126%
Kaiser Permanentemajor	$5,036 - $9,128	126%
Health Net	$2,390 - $12,590	60%
HealthPartners	$2,757 - $5,036	69%
+ 41 smaller / regional plans	$1,275 - $19,167

Government programs also on file: Medicare, Medicaid.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 4,987), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Scripps Memorial Hospital La Jolla is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Scripps Memorial Hospital La Jolla

Compare: Breast lump removal at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.