CMS Price Transparency Data

Breast lump removal

Facility: Adventist Health Howard Memorial

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,155
Cash Discount Price: $595
vs. Medicare Baseline: 0.29x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Adventist Health Howard Memorial is $1,155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $595. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.29x the Medicare baseline. Located in 1 Marcela Dr, Willits, CA.

Cash / Self-Pay

$595

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,155

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: $595 (15%)

Insurance Median: $1,155 (29%)

Cash: $595 (15% of Medicare)

Ins. Median: $1,155 (29% 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
Medi-Cal	$211	5%
Blue Shield Mcare	$288 - $1,149	7%
Tricare	$288 - $1,149	7%
Medicare (plans)	$290 - $1,160	7%
UnitedHealthcare	$316 - $4,445	8%
Aetna	$323 - $3,854	8%
Ah Employee Health Plan - All Plans	$445 - $2,987	11%
Cigna	$467 - $4,882	12%
Western Growers/Pinnacle - All Plans	$579 - $4,308	14%
Healthnet - All Plans	$590 - $4,710	15%
Blue Shield - All Other Plans	$604 - $9,470	15%
Blue Cross Blue Shield	$773 - $13,532	19%
First Health Ppo - All Plans	$1,150 - $4,595	29%
Ghn Ppo - All Plans	$1,150 - $4,595	29%
Brms - All Plans	$1,222 - $4,882	31%
Blue Shield Epn	$1,239 - $9,148	31%

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 $595.
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 Howard Memorial 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.