CMS Price Transparency Data
Breast lump removal
Facility: Scripps Memorial Hospital La Jolla
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $4,265
- Cash Discount Price: $4,987
- vs. Medicare Baseline: 1.07x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Scripps Memorial Hospital La Jolla is $4,265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,987. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.07x the Medicare baseline. Located in 9888 Genesee Avenue, La Jolla, CA.
Cash / Self-Pay
$4,987
Average discount available for prompt cash payment at this facility.
Insurance Median
$4,265
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: $4,987 (125%)
Insurance Median: $4,265 (107%)
Cash: $4,987 (125% of Medicare)
Ins. Median: $4,265 (107% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $424 - $5,036 | 11% |
| UnitedHealthcare | $424 - $5,288 | 11% |
| Radys Cpmg [803] | $1,275 - $1,917 | 32% |
| Blue Cross Blue Shield | $2,390 - $5,036 | 60% |
| Cigna | $2,390 - $5,036 | 60% |
| Mc Alignment [917] | $2,390 - $3,594 | 60% |
| Mc Blue Shield Promise Health Plan [914] | $2,390 - $3,594 | 60% |
| Mc Blue Shield [902] | $2,390 - $3,594 | 60% |
| Mc Health Net [904] | $2,390 - $3,594 | 60% |
| Mc Scan [905] | $2,390 - $3,594 | 60% |
| Mc United [906] | $2,390 - $3,594 | 60% |
| Sharp Comm Med Grp [812] | $2,677 - $4,840 | 67% |
| Sharp Rees Stealy Med Grp [811] | $2,677 - $4,840 | 67% |
| Ucsd [807] | $2,677 - $4,840 | 67% |
| Uh [819] | $2,709 - $4,073 | 68% |
| Bc [814] | $2,757 - $4,145 | 69% |
| Imperial County Phys Med Group [855] | $2,757 - $4,312 | 69% |
| Integrated Health Partners [894] | $2,757 - $4,145 | 69% |
| Perlman Med Group [899] | $2,757 - $4,145 | 69% |
| Blue Shield [230] | $2,773 - $4,504 | 69% |
| Health Net [340] | $2,837 - $12,590 | 71% |
| Hn [815] | $2,837 - $4,265 | 71% |
| Bs [816] | $2,868 - $4,504 | 72% |
| Centivo [581] | $2,868 - $4,312 | 72% |
| Palomar Health [892] | $3,219 - $4,840 | 80% |
| Veba Med Grp [813] | $3,219 - $4,840 | 80% |
| Astiva Mcr Adv [464] | $5,036 | 126% |
| Bc Mcr Adv [830] | $5,036 | 126% |
| Bs Mcr Adv [829] | $5,036 | 126% |
| Central Health Mcr Adv [441] | $5,036 | 126% |
| Clever Care Mcr Adv [465] | $5,036 | 126% |
| D-Snp Mcr Adv [889] | $5,036 | 126% |
| Dsnp/Csnp - Generic [458] | $5,036 | 126% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $5,036 | 126% |
| Family Health Centers Pace Medi-Cal [555] | $5,036 | 126% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $5,036 | 126% |
| Gpmg/Altura - Mcr Adv [888] | $5,036 | 126% |
| Hn Mcr Adv [832] | $5,036 | 126% |
| Humana | $5,036 | 126% |
| Integrated Health Partners - Mcr Adv [895] | $5,036 | 126% |
| Kaiser Northern Ca Region Mcr Adv [386] | $5,036 | 126% |
| La Care Mcr Adv Hmo [612] | $5,036 | 126% |
| Medicare (plans) | $5,036 | 126% |
| Mpmg Mcr Adv [836] | $5,036 | 126% |
| Mpmg [800] | $5,036 | 126% |
| Ocn Mcr Adv [890] | $5,036 | 126% |
| San Diego Pace Medi-Cal [553] | $5,036 | 126% |
| Scan Mcr Adv [835] | $5,036 | 126% |
| Scan [500] | $5,036 | 126% |
| Scan [818] | $5,036 | 126% |
| Sharp Comm Med Grp Mcr Adv [840] | $5,036 | 126% |
| Sharp Health Plan Mcr Adv [531] | $5,036 | 126% |
| Sharp Health Plan Mcr Adv [897] | $5,036 | 126% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $5,036 | 126% |
| St Paul'S Pace Medi-Cal [551] | $5,036 | 126% |
| Ucsd Mcr Adv [873] | $5,036 | 126% |
| Uh Mcr Adv [831] | $5,036 | 126% |
| Uh Palomar Health Mcr Adv [885] | $5,036 | 126% |
| Alignment Health Plan [443] | $5,187 | 130% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $6,072 - $9,128 | 152% |
| Kaiser [380] | $6,072 - $9,128 | 152% |
| Kaiser [383] | $6,072 - $9,128 | 152% |
| Rady Children'S Hospital [825] | $6,534 - $9,823 | 163% |
| Prime Healthcare [614] | $8,561 | 214% |
| Prospect Med Group [893] | $8,813 | 220% |
| Multi Plan Network [470] | $11,314 - $17,010 | 283% |
| First Health Network [330] | $11,952 - $17,969 | 299% |
| Pnoa [615] | $11,952 - $17,969 | 299% |
| Choice Care Network [270] | $12,749 - $19,167 | 319% |
| Healthsmart [350] | $12,749 - $19,167 | 319% |