CMS Price Transparency Data

Breast lump removal

Facility: Marinhealth Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $20,379
Cash Discount Price: $13,241
vs. Medicare Baseline: 5.09x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Marinhealth Medical Center is $20,379. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,241. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 5.09x the Medicare baseline. Located in 250 Bon Air Road, Greenbrae, CA.

Cash / Self-Pay

$13,241

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,379

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: $13,241 (331%)

Insurance Median: $20,379 (509%)

Cash: $13,241 (331% of Medicare)

Ins. Median: $20,379 (509% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 509% of the Medicare baseline (a markup of 409%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
UnitedHealthcare	$2,330	58%
Aetna	$5,526 - $15,623	138%
Brown And Tolan	$5,526	138%
Healthnet Tailored Network	$5,526	138%
Kaiser	$5,526	138%
Marin Cancer Care	$5,526	138%
Ca Prison Health Care Services	$8,842	221%
Cigna	$13,466	337%
Healthnet Enhancedcare	$14,369	359%
Blue Cross Blue Shield	$17,999 - $22,758	450%
Provider Network Of America	$26,250	656%
Canopy	$31,777	794%
Canopy Hill Physicians	$31,777	794%
Blue Shield Cpic/Epo	$32,777	819%
Providers Network Of America	$34,816	870%
Blue Shield Hmo/Ppo	$36,419	910%
Hills Blue Shield Hmo/Ppo	$36,419	910%
Healthnet Hmo/Ppo	$36,861	921%
Healthnet Hmo/Ppo Hill Physicians	$36,861	921%
Blue Shield Aco	$37,751	944%

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 $13,241.
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 Marinhealth 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.