CMS Price Transparency Data

Breast lump removal

Facility: Saint Michael's Medical Center

Billing Code: 19120 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$4,550

about 1.1× the $4,000 Medicare rate · typically $3,393–$5,429

modeled estimate · not a bill or quote

What this hospital charges insurers

$5,119

About the fair price

about $569 over the fair price · 1.3× Medicare

Medicare pays $4,000 Fair price $4,550 This hospital $5,119 Cash price $4,540 Hospital's list price $18,949

How we calculate the fair BaseRate →

How this hospital compares to other NJ hospitals

Highest price of the 9 NJ hospitals we have prices for — worth calling around.

Cheapest $808 Priciest $5,119

Black dot = this hospital, among the 9 NJ hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $4,550 (about 1.1× the $4,000 Medicare rate). Saint Michael's Medical Center charges insurers about $5,119, or about $4,540 in cash — about the fair price. Located in Newark, NJ.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$4,462 - $5,458	112%
Blue Cross Blue Shieldmajor	$4,541	114%
Aetnamajor	$4,541 - $9,626	114%
Cignamajor	$7,257	181%
Humanamajor	$4,541	114%
AmeriHealth	$4,541	114%
Clover Health	$4,722	118%
WellCare	$4,677 - $6,130	117%
+ 5 smaller / regional plans	$4,541 - $9,290

Government programs also on file: Medicare, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 4,540), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Saint Michael's Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Saint Michael's Medical Center

Compare: Breast lump removal at other NJ hospitals

Insurance negotiated median for the same procedure, sorted lowest first.