CMS Price Transparency Data
Breast lump removal
Facility: Clovis Community Medical Center
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $586
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.15x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Clovis Community Medical Center is $586. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.15x the Medicare baseline. Located in 2755 Herndon Ave, Clovis, CA.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$586
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%)
Insurance Median: $586 (15%)
Ins. Median: $586 (15% 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 |
|---|---|---|
| Blue Cross Blue Shield | $65 - $6,354 | 2% |
| Blue Shield | $211 - $5,367 | 5% |
| Cal Caloptima | $211 | 5% |
| Ccs Fresno | $211 | 5% |
| Ccs Kern | $211 | 5% |
| Ccs Kings | $211 | 5% |
| Ccs Madera/Sacramento | $211 | 5% |
| Ccs Mariposa | $211 | 5% |
| Ccs Merced | $211 | 5% |
| Ccs Stanislaus | $211 | 5% |
| Ccs Tulare | $211 | 5% |
| Chdp | $211 | 5% |
| Fresno County Funded Specialty Care | $211 | 5% |
| Generic Care Out Of County | $211 | 5% |
| Generic Ccs Other Counties | $211 | 5% |
| Genetically Handicapped Person | $211 | 5% |
| Gold Coast Medi-Cal | $211 | 5% |
| Medi-Cal Alameda Alliance For Health | $211 | 5% |
| Medi-Cal Blue Shield Promise Health | $211 | 5% |
| Medi-Cal California Health & Wellness Plan | $211 | 5% |
| Medi-Cal Cencal Health | $211 | 5% |
| Medi-Cal Community Health Group | $211 | 5% |
| Medi-Cal Contra Costa Health Plan | $211 | 5% |
| Medi-Cal Health Plan Of San Mateo | $211 | 5% |
| Medi-Cal Inland Empire Health | $211 | 5% |
| Medi-Cal Kern Family Health | $211 | 5% |
| Medi-Cal La Care Health | $211 | 5% |
| Medi-Cal Molina | $211 | 5% |
| Medi-Cal Partnership Health Plan Of Ca | $211 | 5% |
| San Francisco Health Plan Medi-Cal | $211 | 5% |
| Santa Clara Family Health Plan - Premier Health | $211 | 5% |
| Santa Clara Family Health Plan - Valley Health | $211 | 5% |
| Health Plan Of San Joaquin | $316 | 8% |
| Sequoia Pace | $316 | 8% |
| Sante | $327 - $5,036 | 8% |
| Adventist -Mcl Calviva Sub Cap | $348 | 9% |
| Healthnet | $406 | 10% |
| Advantek Table Mountain Rancheria Tribal Member | $586 - $5,036 | 15% |
| Aetna | $586 - $5,036 | 15% |
| Blue Shield 65 Plus Hmo Ehs | $586 - $5,036 | 15% |
| Blue Shield 65 Plus Hmo First Choice | $586 - $5,036 | 15% |
| Blue Shield Hmo-Cvmp/Medpro | $586 - $5,036 | 15% |
| Blue Shield Promise - Imperial | $586 - $5,036 | 15% |
| Blue Shield Saint Agnes | $586 - $5,036 | 15% |
| Blue Shield Sante | $586 - $5,036 | 15% |
| Brand New Day | $586 - $5,036 | 15% |
| Bscphp - Dhmso | $586 - $5,036 | 15% |
| Bscphp - First Choice | $586 - $5,036 | 15% |
| Bscphp Hmo - First Choice | $586 - $5,036 | 15% |
| Care1St Hmo - Ehs | $586 - $5,036 | 15% |
| Cares Act Provider Relief Fund | $586 - $5,036 | 15% |
| Cigna | $586 - $7,438 | 15% |
| Gemcare Hmo | $586 - $5,036 | 15% |
| Generic | $586 - $5,036 | 15% |
| Generic Bscphp | $586 - $5,036 | 15% |
| Generic Victims Of Crime | $586 - $5,036 | 15% |
| Hartford Life Supplement | $586 - $5,036 | 15% |
| Healthnet Hmo - Cvmp/Medpro | $586 - $5,036 | 15% |
| Healthnet Hmo - Dhmso | $586 - $5,036 | 15% |
| Healthnet Hmo - La Salle | $586 - $5,036 | 15% |
| Healthnet Hmo - Sante | $586 - $5,036 | 15% |
| Healthnet Sante | $586 - $5,036 | 15% |
| Healthnet Sante - Sub Cap Dual Risk | $586 - $5,036 | 15% |
| Healthnet Sante Dual Risk | $586 - $5,036 | 15% |
| Humana | $586 - $5,036 | 15% |
| Medi-Cal Innovative Integrated Health | $586 - $5,036 | 15% |
| Medicare (plans) | $586 - $5,036 | 15% |
| Meritage Blue Shield 65 Plus | $586 - $5,036 | 15% |
| Meritage Brand New Day | $586 - $5,036 | 15% |
| Meritage Healthnet Hmo | $586 - $5,036 | 15% |
| Railroad Part A | $586 - $5,036 | 15% |
| Railroad Part A & B | $586 - $5,036 | 15% |
| Railroad Part B | $586 - $5,036 | 15% |
| Sante Sub Cap Healthnet Seniority | $586 - $5,036 | 15% |
| Sante Sub Cap-Blue Shield/Sante | $586 - $5,036 | 15% |
| Sante-Blue Shield/Sante | $586 - $5,036 | 15% |
| Sante-Healthnet Seniority | $586 - $5,036 | 15% |
| Sante-Sub Cap Ma Brand New Day | $586 - $5,036 | 15% |
| Scan Health Plan | $586 - $5,036 | 15% |
| Sequoia Pace - Peak Tpa | $586 - $5,036 | 15% |
| Todays Pyramid | $586 - $5,036 | 15% |
| UnitedHealthcare | $586 - $5,624 | 15% |
| Us Marshal | $586 - $5,036 | 15% |
| Victims Of Crime | $586 - $5,036 | 15% |
| Well Path (Cfmg) | $586 | 15% |
| Wellcare | $586 - $5,036 | 15% |
| Alignment Health Plan | $644 - $5,539 | 16% |
| Champion Health Plan Of California Ma | $644 - $5,539 | 16% |
| Innovative Integrated Health Community Plans Hmo | $644 - $5,539 | 16% |
| Imperial Health Plan Hmo | $674 - $5,791 | 17% |
| Correctcare Integrated Health | $762 - $6,547 | 19% |
| Coalinga State Hospital | $1,172 - $10,072 | 29% |
| Naphcare Inc-Mendota | $1,260 - $10,827 | 31% |
| Kaiser | $4,000 | 100% |
| Generic Multiplan | $8,490 | 212% |
| Phcs | $8,490 | 212% |