CMS Price Transparency Data

Breast lump removal

Facility: Jamaica Hospital Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,864
Cash Discount Price: $3,009
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Jamaica Hospital Medical Center is $4,864. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,009. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.22x the Medicare baseline. Located in 89Th Avenue and Van Wyck Expressway, Jamaica, NY.

Cash / Self-Pay

$3,009

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,864

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: $3,009 (75%)

Insurance Median: $4,864 (122%)

Cash: $3,009 (75% of Medicare)

Ins. Median: $4,864 (122% 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
1999 National Benefit Fund	$578 - $4,001	14%
Hotel Trades Council	$1,912	48%
Empire Blue Priority	$3,134	78%
Create Health Plan	$3,399	85%
Empire	$3,687 - $4,864	92%
Aetna	$3,797 - $4,864	95%
Oscar	$4,018	100%
Healthfirst	$4,134	103%
UnitedHealthcare	$4,215 - $4,864	105%
Cigna	$4,250	106%
Magnacare	$4,555 - $5,593	114%
Fidelis	$4,620 - $4,864	115%
Centivo	$4,679	117%
Beacon Health Strategies	$4,864	122%
Centerlight Healthcare	$4,864	122%
Ghi	$4,864	122%
Hip	$4,864 - $5,159	122%
Metroplus	$4,864 - $5,350	122%
Elderplan	$4,961	124%
Vns	$4,961	124%
Wellcare Of Ny	$5,058	126%
Villagecaremax	$5,107	128%
Humana	$5,155	129%
Senior Whole Health	$5,155	129%
Hamaspik Choice	$5,593	140%
Centers Plan For Healthy Living	$6,080	152%
Emblemhealth	$8,025	201%

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 $3,009.
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 Jamaica Hospital 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.