CMS Price Transparency Data

Breast lump removal

Facility: Pacifica Hospital of the Valley

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,621
Cash Discount Price: $15,293
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Pacifica Hospital of the Valley is $3,621. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,293. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.91x the Medicare baseline. Located in 9449 San Fernando Rd, Sun Valley, CA.

Cash / Self-Pay

$15,293

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,621

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: $15,293 (382%)

Insurance Median: $3,621 (91%)

Cash: $15,293 (382% of Medicare)

Ins. Median: $3,621 (91% 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
Alignment Health	$2,826	71%
America Cash Health Plan	$3,533	88%
Blue Cross Blue Shield	$3,533 - $15,293	88%
Care 1St Health Plan	$3,533	88%
Humana	$3,533	88%
La Health Care	$3,533	88%
Bright Health Group	$3,709	93%
Health Net Of California	$4,416	110%
Aetna	$7,647	191%
Altamed	$15,293	382%
Heritage Provider Network	$15,293	382%
Molina	$15,293	382%

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 $15,293.
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 Pacifica Hospital of the 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.