CMS Price Transparency Data

Breast lump removal

Facility: Adventist Health Tulare

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $405
Cash Discount Price: $342
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Adventist Health Tulare is $405. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $342. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.10x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$342

Average discount available for prompt cash payment at this facility.

Insurance Median

$405

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: $342 (9%)

Insurance Median: $405 (10%)

Cash: $342 (9% of Medicare)

Ins. Median: $405 (10% 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
Blue Cross Blue Shield	$211 - $668	5%
Ccipa Medi-Cal - All Plans	$211	5%
Healthnet Medi-Cal	$211	5%
Medi-Cal	$211	5%
Upn-United Physcn Ntwrk Mcal Profee Only	$211	5%
Aetna	$335	8%
Blue Shield Mcare	$405	10%
Fhcn Pace Mcr Adv - All Plans	$405	10%
Medicare (plans)	$405	10%
Tricare	$405	10%
UnitedHealthcare	$405 - $547	10%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$405	10%
Ah Employee Health Plan - All Plans	$445	11%
Incentive Hlth - All Plans	$445	11%
Cigna	$504	13%
Hs Interplan-All Plans	$506	13%
Cal Forensic Med Grp - All Plans	$526	13%
Blue Shield Epn	$572	14%
Healthnet Hmo/Ppo - All Other Plans	$590	15%
Blue Shield-All Other Plans	$604	15%

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 $342.
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 Tulare 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.