CMS Price Transparency Data

Breast lump removal

Facility: Raritan Bay Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $4,857
  • Cash Discount Price: $4,242
  • vs. Medicare Baseline: 1.21x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Raritan Bay Medical Center is $4,857. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,242. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.21x the Medicare baseline. Located in 530 New Brunswick Ave, Perth Amboy, NJ.
Cash / Self-Pay
$4,242

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,857

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: $4,242 (106%)
Insurance Median: $4,857 (121%)
Cash: $4,242 (106% of Medicare)
Ins. Median: $4,857 (121% 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
Horizon $450 - $6,776 11%
Karna $902 23%
Aetna $933 - $8,419 23%
UnitedHealthcare $1,189 - $10,156 30%
Clover $1,263 32%
Seoul Medical Group $1,452 36%
Activecare First McO $2,915 73%
Amerihealth $3,155 - $3,525 79%
Cigna $3,412 - $5,611 85%
Blue Cross Blue Shield $4,242 106%
Vaccn $4,242 106%
Wellcare $4,242 106%
United Community/Americhoice $4,454 111%
Amerigroup $4,539 113%
Bergen Risk $5,260 131%
Qualcare $5,366 - $6,172 134%
Multiplan - PHCS $5,962 149%
Oxford $8,086 202%
Brighton Health Plan $9,933 248%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 530 New Brunswick Ave, Perth Amboy, NJ 08861
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals