CMS Price Transparency Data

Breast lump removal

Facility: Memorialcare Orange Coast Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $6,586
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Memorialcare Orange Coast Medical Center is $6,586. 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 1.65x the Medicare baseline. Located in 9920 Talbert Avenue, Fountain Valley, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,586

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: $6,586 (165%)

Ins. Median: $6,586 (165% 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
Heritage Provider Network	$1,669	42%
Aetna	$2,257 - $3,854	56%
Cigna	$3,045 - $4,787	76%
Seoul Medical Group	$4,532	113%
Blue Shield	$4,935 - $8,143	123%
Blue Cross Blue Shield	$5,036 - $13,751	126%
Molina	$5,187	130%
Universal Care	$5,288	132%
Central Health	$5,539	138%
Clever Care	$6,043	151%
Healthcare Partners	$6,295 - $13,698	157%
Select Health	$6,798	170%
UnitedHealthcare	$7,756 - $13,282	194%
Monarch Health Plan	$8,108 - $12,590	203%
Healthnet	$10,220 - $14,600	255%
Centivo	$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 $X.
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 Memorialcare Orange Coast 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.