CMS Price Transparency Data

Breast lump removal

Facility: Glens Falls Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $547
Cash Discount Price: $1,000
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Glens Falls Hospital is $547. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,000. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.14x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$1,000

Average discount available for prompt cash payment at this facility.

Insurance Median

$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: $1,000 (25%)

Insurance Median: $547 (14%)

Cash: $1,000 (25% of Medicare)

Ins. Median: $547 (14% 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
Medicaid / KanCare	$184 - $484	5%
Cdphp	$266 - $5,662	7%
Medicare (plans)	$293 - $484	7%
UnitedHealthcare	$293 - $5,299	7%
Blue Cross Blue Shield	$302 - $6,259	8%
Emblem Health Ghi	$333 - $484	8%
Tricare	$333 - $484	8%
Mvp	$368 - $3,949	9%
Aetna	$391 - $4,577	10%
Fidelis	$391 - $4,231	10%
Mvp Commercial	$391 - $6,244	10%
Blue Shield Highmark	$407 - $550	10%
Blue Shield	$523 - $1,352	13%
Cigna	$574 - $842	14%
Hamaspik	$1,396 - $2,844	35%
Nascentia Health Options	$1,396 - $2,844	35%
Empire Plan Nyship	$2,023 - $3,720	51%
Magnacare	$3,282 - $4,531	82%
Emblem	$3,501	88%
Multiplan	$3,720	93%

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 $1,000.
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 Glens Falls 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.