CMS Price Transparency Data

Breast lump removal

Facility: St Joseph's University Medical Center Inc

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $4,343
  • Cash Discount Price: $8,960
  • vs. Medicare Baseline: 1.09x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at St Joseph's University Medical Center Inc is $4,343. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,960. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.09x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$8,960

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,343

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: $8,960 (224%)
Insurance Median: $4,343 (109%)
Cash: $8,960 (224% of Medicare)
Ins. Median: $4,343 (109% 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.

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
Fidelis Care of New Jersey $337 - $4,884 8%
UnitedHealthcare $337 - $5,740 8%
Aetna $420 - $9,489 10%
Ambetter / Centene $450 - $6,977 11%
Amerihealth $450 - $5,705 11%
Clover Health $450 - $4,652 11%
Horizon New Jersey Total Care $450 - $4,652 11%
Wellpoint $450 - $4,652 11%
Blue Cross Blue Shield $528 - $13,245 13%
Consumer Health Network $604 - $8,064 15%
Multiplan $675 - $6,720 17%
Private Healthcare Systems $1,157 - $5,824 29%
Horizon New Jersey Health $1,513 - $2,778 38%
Cigna $1,780 - $8,960 44%
Oxford $4,206 - $5,740 105%
Longevity Health Plan $5,349 134%
Magnacare $6,272 157%
Oscar $8,440 211%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 703 Main St, Paterson, NJ 07503
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals