CMS Price Transparency Data

Breast lump removal

Facility: Garnet Health Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,545
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Garnet Health Medical Center is $3,545. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.89x the Medicare baseline. Located in 707 East Main Street, Middletown, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,545

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%)

Insurance Median: $3,545 (89%)

Ins. Median: $3,545 (89% 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
Magnacare	$1,213 - $1,940	30%
Aetna	$1,335 - $4,888	33%
Local 1199	$1,335 - $3,133	33%
Mvp	$2,108	53%
Emblem Health	$2,207	55%
UnitedHealthcare	$3,262	82%
Cigna	$3,827	96%
Cdphp	$4,881	122%
Fidelis	$4,985	125%
Wellcare	$5,000	125%
Blue Cross Blue Shield	$5,377 - $5,501	134%
Rojw	$8,553	214%
Northwell Direct	$10,020	250%
Geisinger Health Plan	$12,219	305%

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 $X.
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 Garnet Health 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.