CMS Price Transparency Data

Breast lump removal

Facility: Saratoga Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $484
  • Cash Discount Price: $5,948
  • vs. Medicare Baseline: 0.12x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Saratoga Hospital is $484. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,948. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.12x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.
Cash / Self-Pay
$5,948

Average discount available for prompt cash payment at this facility.

Insurance Median
$484

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: $5,948 (149%)
Insurance Median: $484 (12%)
Cash: $5,948 (149% of Medicare)
Ins. Median: $484 (12% 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.

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 - $4,934 7%
Fidelis $293 - $4,531 7%
Medicare (plans) $293 - $484 7%
Blue Cross Blue Shield $302 - $3,468 8%
Tricare $333 - $484 8%
Hamaspik $366 - $6,163 9%
Mvp $368 - $842 9%
UnitedHealthcare $384 - $10,706 10%
Emblem Health Ghi $391 - $532 10%
Aetna $399 - $553 10%
Blue Shield Highmark $407 - $561 10%
Nascentia Health Options $544 14%
Emblem $559 - $6,344 14%
Cigna $574 - $842 14%
Blue Shield $1,558 - $3,749 39%
Mvp Essential Plan $1,875 - $3,749 47%
Mvp Govt Programs $1,875 47%
Empire Plan Nyship $2,635 66%
Mvp Commercial $6,613 - $8,327 165%
Multiplan $8,922 - $10,112 223%
Magnacare $10,706 - $11,301 268%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 211 Church Street, Saratoga Springs, NY 12866
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals