Partial Mastectomy Cost in New Jersey
Partial mastectomy
$4,633Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
New Jersey Medicare physician rate (2026)
+8.1% vs nationalAverage of 2 localities. Office range $674.08–$694.02.
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $2,397 on the Medicare allowed amount for partial mastectomy. Ask whether your procedure can be done at an ambulatory surgery centre.
Medicare pays the hospital a single comprehensive amount for this procedure, covering the facility's share of the encounter including implants and supplies. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Your ZIP in New Jersey
Look up your ZIP code to see whether northern or rest-of-state New Jersey pricing applies, from Newark, Jersey City, and Bergen County down to Trenton, Cherry Hill, and the Jersey Shore.
What partial mastectomy costs at hospitals near you
Everything above is a national average. The hospital you pick in New Jersey moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again.
National vs New Jersey
Where New Jersey ranks for this CPT
CPT 19301 by New Jersey locality
| Locality | Office |
|---|---|
| northern nj | $694.02 |
| rest of new jersey | $674.08 |
PE GPCI ranges from 1.092 to 1.160 in New Jersey. That index is why the same CPT is not one price statewide.
Partial Mastectomy and how New Jersey is priced
New Jersey is split into two payment localities: northern New Jersey, which carries higher adjustments befitting its position in the New York metropolitan orbit, and the rest of the state to the south. Both localities price above the national average, but the northern one ranks among the more expensive in the country. The dividing line means a procedure in Bergen County is approved at a higher amount than the same one in Cherry Hill or along the shore. South Jersey's pricing gravity pulls toward Philadelphia even though its locality is its own.
New Jersey may be the ultimate cross-border care state: North Jersey residents flow into Manhattan hospitals, South Jersey residents into Philadelphia's academic centers, and the state's own large systems compete hard in between. Dense population means most residents have multiple hospitals within a short drive, which is real negotiating leverage for a cash-pay patient. The shore counties see seasonal population surges that strain capacity each summer.
This procedure: A partial mastectomy, commonly called a lumpectomy, removes a breast tumor along with a rim of surrounding healthy tissue while preserving the rest of the breast. It is the surgical core of breast-conserving treatment for early-stage breast cancer. The operation is done under general anesthesia in a hospital or surgery center, usually takes one to two hours, and most patients go home the same day with soreness managed by oral medication.
What Is Partial Mastectomy?
A partial mastectomy, commonly called a lumpectomy, removes a breast tumor along with a rim of surrounding healthy tissue while preserving the rest of the breast. It is the surgical core of breast-conserving treatment for early-stage breast cancer. The operation is done under general anesthesia in a hospital or surgery center, usually takes one to two hours, and most patients go home the same day with soreness managed by oral medication.
What Affects the Cost
- –Lymph node procedures done at the same time, such as sentinel node biopsy with radioactive tracer and dye, are billed as separate surgical codes.
- –Pre-surgical wire or radioactive seed localization to mark a tumor that cannot be felt adds a radiology procedure charge.
- –The anesthesia team bills separately based on the length of the operation.
- –Pathology charges for examining the tumor, the margins, and any lymph nodes are substantial and billed by the lab.
- –Hospital outpatient departments usually cost more than ambulatory surgery centers for the identical operation.
- –If margins come back positive, a second re-excision surgery repeats many of these charges.
Questions to Ask Before Booking
- 1.Will you also do a sentinel lymph node biopsy, and what does that add to the total?
- 2.Is the surgery scheduled at a hospital or an ambulatory surgery center, and can I choose the cheaper setting?
- 3.What happens to my costs if the margins are positive and you need to operate again?
- 4.Are the anesthesiologist and pathology lab in my network?
- 5.Which follow-up visits are included in the 90-day global surgical period?
Other featured procedures in New Jersey
Partial Mastectomy in other states
Partial Mastectomy in New Jersey: questions
The 2026 Medicare physician office rate for CPT 19301 averages $684.05 across 2 New Jersey localities, from $674.08 in REST OF NEW JERSEY to $694.02 in NORTHERN NJ. The hospital physician rate averages $684.05. Enter a ZIP for the exact locality.
Yes. CMS splits New Jersey into 2 payment localities. For this CPT the office physician fee spans $19.94 from the lowest to highest locality. Look up your ZIP code to see whether northern or rest-of-state New Jersey pricing applies, from Newark, Jersey City, and Bergen County down to Trenton, Cherry Hill, and the Jersey Shore.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $137 for the office physician line or $137 for the hospital physician line in New Jersey. Medigap may cover that 20%. This is not the hospital facility fee.
No. $684.05 is only the physician's share. Adding Medicare's facility payment brings the total to about $4,633 in a hospital outpatient department, or about $2,236 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. New Jersey ranks #46 of 51 states on the physician line (8% above the national office rate of $632.61).