CMS Price Transparency Data

Breast lump removal

Facility: Hospital for Special Surgery

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $11,659
Cash Discount Price: $12,750
vs. Medicare Baseline: 2.91x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Hospital for Special Surgery is $11,659. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,750. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 2.91x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$12,750

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,659

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: $12,750 (319%)

Insurance Median: $11,659 (291%)

Cash: $12,750 (319% of Medicare)

Ins. Median: $11,659 (291% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 291% of the Medicare baseline (a markup of 191%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$70 - $12,343	2%
UnitedHealthcare	$5,949 - $11,659	149%
Oxford [1096]	$7,464	187%
Affinity By Molina Health Plan [1005]	$8,105	203%
Geha [1053]	$9,416	235%
Student Resources [1103]	$9,416	235%
Emblem Health [1043]	$10,676 - $12,343	267%
Harvard Pilgrim [1057]	$11,659	291%
Apwu [1016]	$12,245	306%
Cigna	$12,245	306%
Nalc [1090]	$12,245	306%
Qualcare [1101]	$12,245	306%
Wellfleet [1361]	$12,245	306%
Aetna	$12,267	307%
Christian Brothers [1034]	$12,267	307%
Meritain Health [1085]	$12,267	307%
Nippon Life [1092]	$12,267	307%
Webtpa [1356]	$12,267	307%
Connecticare [1039]	$12,343	309%

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 $12,750.
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 Hospital for Special Surgery 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.