CMS Price Transparency Data

Breast lump removal

Facility: Adventist Health Tulare

Billing Code: 19120 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$1,689

about 0.4× the $4,000 Medicare rate · typically $472–$3,923

modeled estimate · not a bill or quote

What this hospital charges insurers

$475

Below the fair price — a good deal

about $1,214 under the fair price · 0.1× Medicare

Medicare pays $4,000 Fair price $1,689 This hospital $475 Cash price $342 Hospital's list price $1,798

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

One of the lower prices — 6 of 8 other CA hospitals charge more for the same procedure.

Cheapest $445 Priciest $523

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $1,689 (about 0.4× the $4,000 Medicare rate). Adventist Health Tulare charges insurers about $475, or about $342 in cash — below the fair price — a good deal. Located in Tulare, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$405 - $547	10%
Blue Cross Blue Shieldmajor	$211 - $668	5%
Aetnamajor	$335	8%
Cignamajor	$504	13%
+ 6 smaller / regional plans	$211 - $526

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 342), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Adventist Health Tulare is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Adventist Health Tulare

Compare: Breast lump removal at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.