CMS Price Transparency Data

Breast lump removal

Facility: Montefiore St Luke's Cornwall

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,888
Cash Discount Price: $4,888
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Montefiore St Luke's Cornwall is $4,888. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,888. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.22x the Medicare baseline. Located in 70 Dubois Street, Newburgh, NY.

Cash / Self-Pay

$4,888

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,888

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: $4,888 (122%)

Insurance Median: $4,888 (122%)

Cash: $4,888 (122% of Medicare)

Ins. Median: $4,888 (122% 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
Healthfirst	$1,156 - $4,888	29%
Affinity	$1,393 - $5,132	35%
Blue Cross Blue Shield	$1,393 - $7,843	35%
Emblem	$1,393 - $30,889	35%
Medicaid / KanCare	$1,393	35%
Hamaspik	$1,463 - $5,279	37%
Magnacare	$1,500 - $3,000	37%
Aetna	$3,515 - $4,839	88%
Oscar	$3,549 - $7,276	89%
Cdphp	$3,642 - $4,888	91%
Geha	$3,932	98%
Meritain Health	$3,932	98%
Nippon Life Insurance	$3,932	98%
Mediblue	$4,741	119%
Fidelis	$4,888 - $5,670	122%
Hudson Valley	$4,888	122%
Point Comfort	$4,888	122%
UnitedHealthcare	$4,888 - $6,801	122%
Villagecaremax	$4,888	122%
Vnsny Choice	$4,888	122%
Centerlight	$5,034	126%
Wellcare	$5,034	126%
Mvp	$5,223	131%
Humana	$5,376	134%
Seiu1199	$5,826	146%
American Postal Workers	$6,801	170%
Northwell	$13,148	329%

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 $4,888.
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 Montefiore St Luke's Cornwall 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.