CMS Price Transparency Data

Breast lump removal

Facility: Robert Wood Johnson University Hospital - Somerset

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $5,036
Cash Discount Price: $6,311
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Robert Wood Johnson University Hospital - Somerset is $5,036. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,311. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.26x the Medicare baseline. Located in 110 Rehill Ave, Somerville, NJ.

Cash / Self-Pay

$6,311

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,036

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: $6,311 (158%)

Insurance Median: $5,036 (126%)

Cash: $6,311 (158% of Medicare)

Ins. Median: $5,036 (126% 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
Blue Cross Blue Shield	$272 - $6,738	7%
Wellpoint	$285 - $4,185	7%
UnitedHealthcare	$1,064 - $8,043	27%
Fidelis Care	$1,094 - $4,185	27%
Aetna	$1,165 - $7,036	29%
Cigna	$3,963 - $5,304	99%
Humana	$4,185	105%
Clover Health	$4,185	105%
First Health	$4,419	110%
Amerihealth	$5,944 - $6,858	149%
Emblem Health	$7,324	183%
Wellcare	$8,328	208%
Qualcare Inc	$9,057	226%

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 $6,311.
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 Robert Wood Johnson University Hospital - Somerset 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.