CMS Price Transparency Data

Breast lump removal

Facility: Adventist Health Delano

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,860
Cash Discount Price: $1,059
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Adventist Health Delano is $3,860. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,059. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.96x the Medicare baseline. Located in 1401 Garces Highway, Delano, CA.

Cash / Self-Pay

$1,059

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,860

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: $1,059 (26%)

Insurance Median: $3,860 (96%)

Cash: $1,059 (26% of Medicare)

Ins. Median: $3,860 (96% 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
Dignty Hlth Mcal Op Only	$211	5%
Kaiser Medi-Cal Ip/Op Only	$211	5%
Medi-Cal	$211	5%
Universal Care Mcal	$211	5%
Healthnet Medi-Cal	$251	6%
Kern Health System Mcal	$266	7%
Blue Cross Blue Shield	$353 - $4,408	9%
Cirugia Sin Fornteras (Csf) - All Plans	$500	12%
Blue Shield Epn - All Other Plans	$1,160	29%
Coventry- All Plans	$3,178	79%
Healthnet- All Other Plans	$3,440	86%
Blue Shield Non-Epn	$3,443	86%
UnitedHealthcare	$3,621 - $5,036	91%
County Of Kern Network - All Plans	$3,708	93%
Gem Care- All Plans	$3,708	93%
Aetna	$3,909	98%
Foundation For Medical Care Of Kern County - All P	$3,973	99%
Cigna	$4,238	106%
Western Growers - All Plans	$4,291	107%
Bakersfield Fam Med Grp-All Plans	$5,036	126%
Healthnet Mcr Adv	$5,036	126%
Kern Mcr Adv Dual Dnsp-All Other Plans	$5,036	126%
Medicare (plans)	$5,036 - $8,057	126%
Tricare	$5,036	126%
Universal Care Mcr- All Other Plans	$5,036	126%
Kaiser Comm Ip/Op Only- All Other Plans	$8,662	217%
Ah Employee Health Plan - All Plans	$9,065	227%
Centivo - All Plans	$11,331	283%

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 $1,059.
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 Adventist Health Delano 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.