CMS Price Transparency Data

Breast lump removal

Facility: Adventist Health Tehachapi Valley

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $523
Cash Discount Price: $489
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Adventist Health Tehachapi Valley is $523. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $489. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.13x the Medicare baseline. Located in 1100 Magellan, Tehachapi, CA.

Cash / Self-Pay

$489

Average discount available for prompt cash payment at this facility.

Insurance Median

$523

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: $489 (12%)

Insurance Median: $523 (13%)

Cash: $489 (12% of Medicare)

Ins. Median: $523 (13% 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
Kaiser Medi-Cal Ip/Op Only	$211	5%
Medi-Cal	$211	5%
Universal Ipa Mcal Op/Profee Only	$211	5%
Bc Mcal	$217	5%
Healthnet Medi-Cal	$259	6%
Khs-Kern Hlth Systm Mcal	$272	7%
Healthnet Mcare	$304 - $409	8%
Medicare (plans)	$304	8%
Tricare	$304 - $409	8%
Universal Ipa Mcr Adv Op/Profee Only-All Other Pla	$304 - $409	8%
Aetna	$359 - $863	9%
Network Providers- All Plans	$389 - $445	10%
UnitedHealthcare	$409 - $547	10%
Ah Employee Health Plan - All Plans	$449 - $960	11%
Cigna	$467 - $1,415	12%
Oscar Health Plan- All Plans	$470 - $6,400	12%
Coventry- All Plans	$490 - $1,631	12%
Kaiser Ip/Op Only- All Other Plans	$523	13%
Western Grwrs/Pinnacle - All Plans	$568 - $761	14%
Blue Shield Epn- All Other Plans	$572 - $766	14%
Healthnet- All Other Plans	$595 - $1,395	15%
Blue Shield Non-Epn	$604 - $906	15%
Centivo - All Plans	$613 - $685	15%
Blue Cross Blue Shield	$869 - $1,102	22%
Klhp-Kern Legacy Epo -All Other Plans	$906	23%

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 $489.
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 Tehachapi Valley 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.