CMS Price Transparency Data

Breast lump removal

Facility: Mt Sinai Hospital Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,108
Cash Discount Price: $1,147
vs. Medicare Baseline: 0.53x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Mt Sinai Hospital Medical Center is $2,108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,147. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.53x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$1,147

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,108

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: $1,147 (29%)

Insurance Median: $2,108 (53%)

Cash: $1,147 (29% of Medicare)

Ins. Median: $2,108 (53% 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
Partners In Hlth - All Plans	$656	16%
Blue Cross Blue Shield	$733 - $4,196	18%
Compsych Ip/Op Only - All Plans	$983	25%
Healthlink Hmo	$1,065	27%
Hfn Platinum	$1,065	27%
Healthlink Ppo - All Other Plans	$1,147	29%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$1,147	29%
Hfn Epo	$1,311	33%
Multiplan Complementary Ntwrk	$1,311	33%
Hfn Ppo - All Other Plans	$1,442	36%
Ambetter / Centene	$1,721 - $4,615	43%
Oscar - All Plans	$1,803	45%
Aetna	$2,008 - $3,704	50%
Family Health Network Mcaid - All Plans	$2,008	50%
Cigna	$2,026 - $3,944	51%
Molina Mcaid	$2,108	53%
Tricare	$4,070	102%
Va Healthnet - All Plans	$4,070	102%
Advocate Physician Prtnrs Mcr	$4,196	105%
Cenpatico Illinicare Dual	$4,196	105%
Cenpatico Illinicare Mcr - All Other Plans	$4,196	105%
Humana	$4,196 - $5,146	105%
Lawndale Christian - All Plans	$4,196	105%
Meridian/Harmony D-Snp - All Plans	$4,196	105%
Nextlevel Hlth Icp Fhp Aca - All Plans	$4,196	105%
Harmony Behavioral Htlh - All Plans	$4,322	108%
Zing Mcr Adv - All Plans	$4,364	109%
Molina Mcr - All Other Plans	$4,406	110%
Advocate Physician Prtnrs - All Other Plans	$4,615	115%

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 $1,147.
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 Mt Sinai Hospital 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.