CMS Price Transparency Data

Breast lump removal

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,751
Cash Discount Price: $4,540
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Saint Clare's Hospital/ Denville Campus is $4,751. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,540. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.19x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$4,540

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,751

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: $4,540 (113%)

Insurance Median: $4,751 (119%)

Cash: $4,540 (113% of Medicare)

Ins. Median: $4,751 (119% 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
UnitedHealthcare	$2,150 - $8,190	54%
Brighton Health Plan Solutions (Fka Magnacare)	$3,519	88%
Humana	$3,633	91%
Aetna	$4,541 - $9,626	114%
Amerihealth	$4,541	114%
Clover Health	$4,541	114%
Horizon	$4,541 - $9,440	114%
Medicare (plans)	$4,541	114%
Tricare	$4,541	114%
Wellcare	$4,541 - $6,130	114%
Wellpoint Amerigroup	$4,541	114%
Ally-Align (Fka Spartan Health Plan)	$4,768	119%
Employer Direct Healthcare	$6,357	159%
Cigna	$7,017	175%
Fairprice Healthcare Holdings - Fphh	$7,265	182%
Coventry	$9,081	227%

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 $4,540.
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 Saint Clare's Hospital/ Denville Campus 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.