CMS Price Transparency Data
Breast lump removal
Facility: Coastal Communities Hospital
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $5,011
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.25x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Coastal Communities Hospital is $5,011. 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 1.25x the Medicare baseline. Located in 2701 S Bristol St, Santa Ana, CA.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$5,011
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: $5,011 (125%)
Ins. Median: $5,011 (125% 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 |
|---|---|---|
| Kpc Healthcare Inc | $253 - $6,295 | 6% |
| Healthcare Partners | $302 | 8% |
| Hollywood Presbyterian | $302 - $5,011 | 8% |
| Kaiser | $302 - $5,011 | 8% |
| Medi-Cal Hmo/Non Contract | $302 | 8% |
| Medicaid / KanCare | $302 | 8% |
| Altamed Health Services | $423 - $5,011 | 11% |
| Caloptima | $423 - $5,036 | 11% |
| Choc Health Alliance | $423 | 11% |
| County Of Orange | $423 | 11% |
| Family Choice | $423 | 11% |
| Heritage Provider Network | $423 - $5,815 | 11% |
| Prospect Health Plan | $423 - $7,554 | 11% |
| Aetna | $2,710 | 68% |
| Monarch | $4,263 - $5,011 | 107% |
| Champus | $4,834 | 121% |
| Blue Shield | $5,011 - $19,093 | 125% |
| Central Health Plan Of California | $5,011 | 125% |
| Champion Health Plan | $5,011 | 125% |
| Citizens Choice Health Plan | $5,011 | 125% |
| Clever Care Health Plan | $5,011 | 125% |
| For Your Benefit | $5,011 | 125% |
| Health Net | $5,011 - $8,639 | 125% |
| Healthcare Partners Sr Hmo | $5,011 | 125% |
| Heritage | $5,011 | 125% |
| Humana | $5,011 | 125% |
| Onecare | $5,011 | 125% |
| Onecare Connect | $5,011 | 125% |
| Other Senior Non Contract | $5,011 | 125% |
| Scan Health Plan | $5,011 | 125% |
| UnitedHealthcare | $5,011 - $5,498 | 125% |
| Us Federal Marshall/Department Of Immigration | $5,011 | 125% |
| Velocity Provider Network Sr | $5,011 | 125% |
| Verda Health Plan Sr | $5,011 | 125% |
| Veterans Administration | $5,011 | 125% |
| Choice Physicians Network | $5,036 | 126% |
| Easy Choice Health Plan | $5,036 | 126% |
| Imperial Health Plan Of Ca | $5,036 | 126% |
| Innovative Integrated Health | $5,036 | 126% |
| Medcare Partners | $5,036 | 126% |
| Self Pay Ab774/Cbo Use Only | $5,036 | 126% |
| Us Dept Of Labor | $5,036 | 126% |
| Victim Of Violent Crime | $5,036 | 126% |
| Victoria Hospice | $5,036 | 126% |
| Monarch Health Plan | $5,365 | 134% |
| Brand New Day | $5,613 | 140% |
| Prime Health Srvs | $5,763 | 144% |
| Coventry Auto Network | $6,028 | 151% |
| Prime Health Srvs/Wc | $6,028 | 151% |
| Interplan | $6,095 | 152% |
| Coventry Wc | $6,262 | 157% |
| County Of Orange/Custody/Advanced Medmgt | $6,264 | 157% |
| Veterans Evaluation Services | $6,295 | 157% |
| Multiplan | $6,564 - $35,000 | 164% |
| Three Rivers | $6,564 | 164% |
| Velocity National Provider Network Wc | $6,698 | 167% |
| Workers Comp State Of California | $6,698 | 167% |
| Cigna | $6,727 | 168% |
| Staywell/Island Home Ins | $7,050 | 176% |
| Three Rivers Network | $8,813 | 220% |
| Velocity National Provider Network Ppo | $8,813 | 220% |
| Ihhi Reciprocity | $15,000 | 375% |
| Healthsmart | $37,500 | 937% |