CMS Price Transparency Data

Breast lump removal

Facility: Harlem Hospital Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,666
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Harlem Hospital Center is $2,666. 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 0.67x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,666

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: $2,666 (67%)

Ins. Median: $2,666 (67% 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
Aetna	$367 - $2,489	9%
Healthfirst	$388 - $4,256	10%
Wellcare	$524	13%
Fidelis	$698 - $6,435	17%
Metroplus	$1,200 - $4,256	30%
Amidacare	$1,892	47%
Blue Cross Blue Shield	$1,892 - $4,531	47%
Carelon	$1,892 - $3,580	47%
Senior Whole Health	$1,892	47%
United	$1,892 - $3,260	47%
United Behavioral Health	$1,892 - $2,081	47%
Affinity	$1,930 - $4,256	48%
Carelon (Amida Care)	$1,930	48%
Vnsny	$1,930 - $4,531	48%
Emblem	$2,365 - $5,664	59%
Local 1199	$2,666	67%
Oxford	$2,695 - $3,052	67%
Centerlight	$2,754	69%
Magnacare	$4,131	103%
Cigna	$4,285	107%
Multiplan	$4,406	110%
Oscar	$4,454	111%
Elderplan	$4,531	113%
Vaccn	$4,531	113%
Villagecare Max	$4,682	117%
Centers Plan For Healthy Living	$4,713	118%

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 Harlem Hospital 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.