CMS Price Transparency Data

Breast lump removal

Facility: Sisters of Charity Hospital

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$496

about 0.1× the $4,000 Medicare rate · typically $424–$1,281

modeled estimate · not a bill or quote

Medicare pays $4,000 Fair price $496 Cash price $737 Hospital's list price $737

How we calculate the fair BaseRate →

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	$280 - $449	7%
Blue Cross Blue Shieldmajor	$184 - $481	5%
Aetnamajor	$419	10%
Cignamajor	$399 - $579	10%
Humanamajor	$419	10%
Amerigroup	$184	5%
Fidelis Care	$419 - $479	10%
Independent Health	$184 - $422	5%
Molina	$414	10%
MVP Health Care	$508	13%
UPMC Health Plan	$719	18%
WellCare	$419 - $439	10%
+ 16 smaller / regional plans	$184 - $496

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

Excludes 2 rental-network / third-party entries (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 737), 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 Sisters of Charity Hospital 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 Sisters of Charity Hospital

Compare: Breast lump removal at other NY hospitals

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