CMS Price Transparency Data

Breast lump removal

Facility: Kenmore Mercy Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $399
Cash Discount Price: $737
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Kenmore Mercy Hospital is $399. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $737. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.10x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$737

Average discount available for prompt cash payment at this facility.

Insurance Median

$399

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: $737 (18%)

Insurance Median: $399 (10%)

Cash: $737 (18% of Medicare)

Ins. Median: $399 (10% 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
Amerigroup [350102]	$184	5%
Excellus Rochester McD [350117]	$184	5%
Vna Option Mltc [350110]	$184	5%
Medicaid / KanCare	$184 - $399	5%
Crime Victims [100176]	$184	5%
Tuscarora Nation [550120]	$184	5%
Independent Health Essential [100166]	$184	5%
Blue Cross Blue Shield	$184 - $481	5%
UnitedHealthcare	$280 - $449	7%
Univera Healthcare [100169]	$343 - $444	9%
Univera Healthcare Essential [100170]	$343	9%
Beacon Essential [350122]	$359 - $479	9%
VA Veterans Affairs [700001]	$359	9%
Medicare (plans)	$393 - $496	10%
Cigna	$399 - $579	10%
Fallon Health [450115]	$399	10%
Covid19 Hrsa [45013]	$399	10%
Hospice [550001]	$399	10%
Tricare	$399	10%
Champ VA [700002]	$399	10%
Seneca Nation [450119]	$399	10%
Catholic Health Life Pace [400005]	$399	10%
Molina Essential [100167]	$414	10%
Humana	$419	10%
Fidelis Dual Advantage [450120]	$419	10%
Aetna	$419	10%
Wellcare Fidelis Dual [450451]	$419	10%
Iha First Choice [800001]	$422	11%
Independent Health [100165]	$422	11%
Wellcare [450129]	$439	11%
Fidelis Essential [100163]	$439	11%
Ghi [100153]	$439	11%
Fidelis Exchange [100164]	$479	12%
Beacon Health Options [100023]	$479	12%
No Fault [114001]	$496	12%
Federal Workers Compensation [500100]	$496	12%
Mvp Healthcare [100168]	$508	13%
UPMC Health Plan [100181]	$719	18%

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 $737.
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 Kenmore Mercy 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.