CMS Price Transparency Data

Breast lump removal

Facility: Carolina East Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,056
Cash Discount Price: $907
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Carolina East Medical Center is $1,056. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $907. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.26x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$907

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,056

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: $907 (23%)

Insurance Median: $1,056 (26%)

Cash: $907 (23% of Medicare)

Ins. Median: $1,056 (26% 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
Humana	$379	9%
Inclusive Health (Nchirp)-All Plans	$379	9%
Tricare	$379	9%
Pamlico Co Jail-All Plans	$402	10%
UnitedHealthcare	$529	13%
Craven Co. Jail Systems - All Plans	$569	14%
Medcost Ppo Employees And Retirees	$993	25%
Medcost Ppo Ultra (Employees)	$993	25%
Blue Cross Blue Shield	$1,056	26%
Medcost Ppo City Employees	$1,101	28%
Medcost Ppo County Employee	$1,145	29%
Benefit Mgmt, Svcs-All Plans	$1,285	32%
Medcost Benefit Svc-All Other Plans	$1,336	33%
Aetna	$1,340	33%
Acs Consult Svc Inc-All Plans	$1,366	34%
Medcost Ppo Standard	$1,366	34%
Cigna	$1,376	34%

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 $907.
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 Carolina East 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.