CMS Price Transparency Data

Breast lump removal

Facility: Modoc Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,569
Cash Discount Price: $5,558
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Modoc Medical Center is $4,569. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,558. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.14x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$5,558

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,569

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: $5,558 (139%)

Insurance Median: $4,569 (114%)

Cash: $5,558 (139% of Medicare)

Ins. Median: $4,569 (114% 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
Adv Med Mgmt - All Plans	$211	5%
Medi-Cal	$211	5%
Medi-Cal 7/1/24	$211	5%
Partnership Hp - All Plans	$738	18%
Blue Shield Comm - All Other Plans	$1,800	45%
Blue Shield Mcr Adv	$3,009	75%
Blue Shield Va	$3,009	75%
UnitedHealthcare	$3,009 - $5,280	75%
Tricare	$3,168	79%
Healthnet Mcr Adv	$3,200	80%
Multiplan Wc	$3,800	95%
Ntwrks By Design Wc - All Plans	$3,960	99%
Integrated Hp Wc	$4,000	100%
Blue Shield Exch	$4,568	114%
Blue Cross Blue Shield	$4,569 - $5,077	114%
Carelon - All Plans	$5,077	127%
Corvel - All Plans	$5,224	131%
Aetna	$5,280	132%
Coventry/First Health - All Plans	$5,280	132%
Galaxy Health - All Plans	$5,280	132%
Healthnet Comm - All Other Plans	$5,280	132%
Hmn - All Plans	$5,280	132%
Integrated Hp - All Other Plans	$5,280	132%
Interplan - All Plans	$5,280	132%
Multiplan - All Other Plans	$5,280	132%
Superior Ca Ppo - All Plans	$5,280	132%

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 $5,558.
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 Modoc Medical Center 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.