CMS Price Transparency Data

Breast lump removal

Facility: Essentia Health St Joseph's Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $4,113
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.03x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Essentia Health St Joseph's Medical Center is $4,113. 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 1.03x the Medicare baseline. Located in 523 North 3Rd Street, Brainerd, MN.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,113

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: $4,113 (103%)
Ins. Median: $4,113 (103% 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
Primewest $3,675 92%
Itasca Med Care $3,829 96%
Advocare/Security Health $4,113 103%
Blue Cross Blue Shield $4,113 - $14,092 103%
Freedom Blue Ppo $4,113 103%
Healthpartners Care Msho / Mcr Adv $4,113 103%
Imcare Msho Pcc Prime $4,113 103%
Imcare Msho Ref Req $4,113 103%
Medica Advantage Solutions $4,113 103%
Medica Msho/Dual Solutions $4,113 103%
Medica Prime Solution Group $4,113 103%
Medicare (plans) $4,113 103%
Nd Va Administration $4,113 103%
Platinum Blue/Vantage Blue $4,113 103%
Primewest Msho $4,113 103%
Secure Blue Msho $4,113 103%
Ubh Cost Plan $4,113 103%
Ubh Msho $4,113 103%
Ucare Msho $4,113 103%
UnitedHealthcare $4,113 103%
Blue Plus Pmap Pcc Prime $13,029 326%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 523 North 3Rd Street, Brainerd, MN 56401
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals