CMS Price Transparency Data

Breast lump removal

Facility: Memorial Hospital for Cancer and Allied Diseases

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,547
Cash Discount Price: $4,500
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Memorial Hospital for Cancer and Allied Diseases is $2,547. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,500. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.64x the Medicare baseline. Located in 1275 York Ave, New York, NY.

Cash / Self-Pay

$4,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,547

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: $4,500 (112%)

Insurance Median: $2,547 (64%)

Cash: $4,500 (112% of Medicare)

Ins. Median: $2,547 (64% 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
Emblem	$184 - $5,330	5%
Fidelis	$485 - $5,026	12%
Aetna	$485 - $9,784	12%
Healthfirst	$485 - $4,467	12%
Metroplus	$485 - $4,487	12%
Empire	$1,856 - $8,769	46%
Magnacare	$2,160 - $5,522	54%
Oxford	$2,214 - $10,824	55%
Urn	$2,340 - $4,901	58%
6 Degrees Health	$2,400 - $5,522	60%
Cigna	$2,680 - $7,041	67%
Multiplan	$2,700 - $6,213	67%
UnitedHealthcare	$2,750 - $12,424	69%

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 $4,500.
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 Memorial Hospital for Cancer and Allied Diseases 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.