CMS Price Transparency Data

Breast lump removal

Facility: The University Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,368
Cash Discount Price: $5,023
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at The University Hospital is $4,368. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,023. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.09x the Medicare baseline. Located in 150 Bergen St, Newark, NJ.

Cash / Self-Pay

$5,023

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,368

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: $5,023 (126%)

Insurance Median: $4,368 (109%)

Cash: $5,023 (126% of Medicare)

Ins. Median: $4,368 (109% 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
Horizon	$469 - $8,749	12%
Amerihealth	$650 - $4,368	16%
United	$2,859	71%
Aetna	$3,751 - $7,129	94%
Fidelis	$3,751 - $4,368	94%
UnitedHealthcare	$3,751 - $4,368	94%
Wellpoint	$3,825	96%
Clover Health	$4,368	109%
First Health	$8,942	224%
Americare	$9,581	240%
Qualcare	$9,581	240%
Correctional Medical Services	$10,220	255%
Multiplan	$10,220	255%
First Trenton	$11,497	287%
Managed Care Inc	$11,497	287%
Consumer Health Network	$12,136	303%
Three Rivers	$12,136	303%

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 $5,023.
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 The University Hospital 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.