CMS Price Transparency Data

Breast lump removal

Facility: Southern Ocean Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $5,022
Cash Discount Price: $4,185
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Southern Ocean Medical Center is $5,022. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,185. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.26x the Medicare baseline. Located in 1140 Rt 72 W, Manahawkin, NJ.

Cash / Self-Pay

$4,185

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,022

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: $4,185 (105%)

Insurance Median: $5,022 (126%)

Cash: $4,185 (105% of Medicare)

Ins. Median: $5,022 (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
Karna	$875	22%
UnitedHealthcare	$1,189 - $10,216	30%
Clover	$1,263	32%
Aetna	$1,298 - $9,383	32%
Horizon	$1,361 - $6,412	34%
Seoul Medical Group	$1,438	36%
Qualcare	$2,255 - $6,369	56%
Cigna	$3,586 - $5,611	90%
Blue Cross Blue Shield	$4,185	105%
Vaccn	$4,185	105%
Wellcare	$4,185	105%
United Community/Americhoice	$4,394	110%
Bergen Risk	$5,260	131%
Multiplan - PHCS	$5,962	149%
Amerihealth	$6,091 - $6,899	152%
Oxford	$8,251	206%
Brighton Health Plan	$9,933	248%

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 $4,185.
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 Southern Ocean Medical Center 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.