CMS Price Transparency Data

Breast lump removal

Facility: Columbia Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $583
Cash Discount Price: $1,094
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Columbia Memorial Hospital is $583. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,094. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.15x the Medicare baseline. Located in 71 Prospect Avenue, Hudson, NY.

Cash / Self-Pay

$1,094

Average discount available for prompt cash payment at this facility.

Insurance Median

$583

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: $1,094 (27%)

Insurance Median: $583 (15%)

Cash: $1,094 (27% of Medicare)

Ins. Median: $583 (15% 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
UnitedHealthcare	$181 - $3,648	5%
Medicaid / KanCare	$184 - $1,872	5%
Mvp	$317 - $3,932	8%
Cdphp	$321 - $4,573	8%
Blue Cross Blue Shield	$322 - $4,951	8%
Medicare (plans)	$340 - $561	8%
Tricare	$385 - $561	10%
Hamaspik	$423 - $2,546	11%
Fidelis	$430 - $4,758	11%
Blue Shield Highmark	$452 - $601	11%
Aetna	$466 - $4,667	12%
Emblem	$559 - $3,383	14%
Cigna	$572 - $713	14%
Emblem Health Ghi	$620 - $768	15%
Magnacare	$842 - $4,341	21%
Empire Plan Nyship	$930 - $4,951	23%
Multiplan	$985 - $5,074	25%
Herrington Diversified Pdh	$1,094 - $5,638	27%
Mvp Commercial	$1,645 - $4,082	41%
Blue Shield	$6,215 - $6,586	155%

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 $1,094.
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 Columbia Memorial 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.