CMS Price Transparency Data

Breast lump removal

Facility: Albany Medical Center Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $567
  • Cash Discount Price: $716
  • vs. Medicare Baseline: 0.14x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Albany Medical Center Hospital is $567. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $716. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.14x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.
Cash / Self-Pay
$716

Average discount available for prompt cash payment at this facility.

Insurance Median
$567

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: $716 (18%)
Insurance Median: $567 (14%)
Cash: $716 (18% of Medicare)
Ins. Median: $567 (14% 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.

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
Medicaid / KanCare $184 - $484 5%
Mvp Commercial $212 - $4,228 5%
UnitedHealthcare $212 - $4,510 5%
Empire Plan Nyship $226 - $8,696 6%
Magnacare $226 - $4,510 6%
Multiplan $240 - $4,792 6%
Cdphp $266 - $6,661 7%
Aetna $282 - $5,638 7%
Blue Shield $282 - $6,967 7%
Medicare (plans) $293 - $561 7%
Fidelis $308 - $7,749 8%
Blue Cross Blue Shield $323 - $8,696 8%
Tricare $333 - $484 8%
Blue Shield Highmark $346 - $995 9%
Hamaspik $366 - $6,163 9%
Mvp $368 - $4,305 9%
Nascentia $430 - $532 11%
Emblem Health Ghi $434 - $1,050 11%
Nascentia Health Options $544 14%
Emblem $559 - $7,533 14%
Cigna $574 - $842 14%
Nys Department Of Corrections $891 - $1,072 22%
Mvp Essential Plan $4,025 101%
Emblem_Ghi $10,045 251%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 43 New Scotland Avenue, Mail Code 34, Albany, NY 12208
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals