CMS Price Transparency Data

Breast lump removal

Facility: Loma Linda University Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $7,298
Cash Discount Price: $5,964
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Loma Linda University Medical Center is $7,298. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,964. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.82x the Medicare baseline. Located in 11234 Anderson St, Loma Linda, CA.

Cash / Self-Pay

$5,964

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,298

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: $5,964 (149%)

Insurance Median: $7,298 (182%)

Cash: $5,964 (149% of Medicare)

Ins. Median: $7,298 (182% 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
Inland Empire Health Plan (Iehp)	$362 - $4,865	9%
Kaiser Foundation Hospitals	$400 - $8,840	10%
Adventist Health	$2,651 - $4,865	66%
Lluh Dept Of Risk Management	$2,651	66%
Blue Shield Of California	$3,166 - $4,852	79%
Alpha Care Medical Group	$4,865 - $7,298	122%
Dignity Health	$4,865 - $7,298	122%
Epic Health Plan	$4,865 - $6,568	122%
UnitedHealthcare	$4,865 - $16,122	122%
Upland Medical Group	$4,865	122%
Vantage Medical Group	$4,865 - $7,298	122%
Prime Health Services	$5,157 - $11,266	129%
Riverside University Health System	$5,352	134%
Blue Cross Blue Shield	$5,806 - $7,764	145%
Molina Healthcare Of Ca	$6,520	163%
Multiplan	$7,752 - $9,940	194%
Preferred Health Network	$7,910	198%
Global Benefits Group	$7,952	199%
Temecula Valley Physicians Medical Group	$7,952	199%
Heritage Provider Network	$7,979	199%
Aetna	$8,114	203%
Cigna	$8,483 - $9,808	212%
Networks By Design	$8,615	215%
Central Health Plan	$10,603	265%
Galaxy Health	$11,266	282%
Health Management Network	$11,929	298%

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 $5,964.
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 Loma Linda University Medical 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.