Partial Mastectomy Cost in California
Partial mastectomy
$4,633Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
California Medicare physician rate (2026)
+2.0% vs nationalAverage of 29 localities. Office range $619.76–$725.80.
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $2,397 on the Medicare allowed amount for partial mastectomy. Ask whether your procedure can be done at an ambulatory surgery centre.
Medicare pays the hospital a single comprehensive amount for this procedure, covering the facility's share of the encounter including implants and supplies. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What partial mastectomy costs at hospitals near you
Everything above is a national average. The hospital you pick in California moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again.
National vs California
Where California ranks for this CPT
CPT 19301 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $725.80 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $714.01 |
| san francisco-oakland-berkeley (marin cnty) | $707.35 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $704.47 |
| napa | $680.91 |
| vallejo | $676.76 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $657.49 |
| santa rosa-petaluma | $652.80 |
| oxnard-thousand oaks-ventura | $649.50 |
| santa cruz-watsonville | $647.00 |
| riverside-san bernardino-ontario | $646.99 |
| san diego-chula vista-carlsbad | $646.34 |
| sacramento-roseville-folsom | $640.63 |
| santa maria-santa barbara | $638.64 |
| salinas | $638.10 |
| san luis obispo-paso robles | $629.13 |
| bakersfield | $626.62 |
| el centro | $620.19 |
| chico | $619.76 |
| fresno | $619.76 |
| hanford-corcoran | $619.76 |
| madera | $619.76 |
| merced | $619.76 |
| modesto | $619.76 |
| redding | $619.76 |
| stockton | $619.76 |
| visalia | $619.76 |
| yuba city | $619.76 |
| rest of california | $619.76 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
Partial Mastectomy and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: A partial mastectomy, commonly called a lumpectomy, removes a breast tumor along with a rim of surrounding healthy tissue while preserving the rest of the breast. It is the surgical core of breast-conserving treatment for early-stage breast cancer. The operation is done under general anesthesia in a hospital or surgery center, usually takes one to two hours, and most patients go home the same day with soreness managed by oral medication.
What Is Partial Mastectomy?
A partial mastectomy, commonly called a lumpectomy, removes a breast tumor along with a rim of surrounding healthy tissue while preserving the rest of the breast. It is the surgical core of breast-conserving treatment for early-stage breast cancer. The operation is done under general anesthesia in a hospital or surgery center, usually takes one to two hours, and most patients go home the same day with soreness managed by oral medication.
What Affects the Cost
- –Lymph node procedures done at the same time, such as sentinel node biopsy with radioactive tracer and dye, are billed as separate surgical codes.
- –Pre-surgical wire or radioactive seed localization to mark a tumor that cannot be felt adds a radiology procedure charge.
- –The anesthesia team bills separately based on the length of the operation.
- –Pathology charges for examining the tumor, the margins, and any lymph nodes are substantial and billed by the lab.
- –Hospital outpatient departments usually cost more than ambulatory surgery centers for the identical operation.
- –If margins come back positive, a second re-excision surgery repeats many of these charges.
Questions to Ask Before Booking
- 1.Will you also do a sentinel lymph node biopsy, and what does that add to the total?
- 2.Is the surgery scheduled at a hospital or an ambulatory surgery center, and can I choose the cheaper setting?
- 3.What happens to my costs if the margins are positive and you need to operate again?
- 4.Are the anesthesiologist and pathology lab in my network?
- 5.Which follow-up visits are included in the 90-day global surgical period?
Other featured procedures in California
Partial Mastectomy in other states
Partial Mastectomy in California: questions
The 2026 Medicare physician office rate for CPT 19301 averages $645.52 across 29 California localities, from $619.76 in CHICO to $725.80 in SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY). The hospital physician rate averages $645.52. Enter a ZIP for the exact locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $106.04 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $129 for the office physician line or $129 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
No. $645.52 is only the physician's share. Adding Medicare's facility payment brings the total to about $4,633 in a hospital outpatient department, or about $2,236 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. California ranks #40 of 51 states on the physician line (2% above the national office rate of $632.61).