CMS Price Transparency Data

Breast lump removal

Facility: Essentia Health St Marys - Detroit Lakes

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,707
Cash Discount Price: $2,978
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Essentia Health St Marys - Detroit Lakes is $3,707. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,978. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.93x the Medicare baseline. Located in 1027 Washington Ave, Detroit Lakes, MN.

Cash / Self-Pay

$2,978

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,707

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: $2,978 (74%)

Insurance Median: $3,707 (93%)

Cash: $2,978 (74% of Medicare)

Ins. Median: $3,707 (93% 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
Healthpartners Care Pmap	$1,805	45%
Sanford Healthplan	$1,990 - $6,781	50%
Blue Cross Blue Shield	$2,088 - $16,780	52%
Medica Uplan	$2,950	74%
Ucare	$3,052	76%
Healthpartners	$3,117 - $3,405	78%
Medica	$3,238 - $3,600	81%
Wea	$3,340 - $3,572	83%
Cigna	$3,405	85%
Healthpartners Pcc Prime	$3,405	85%
America'S Ppo	$3,595	90%
Primewest	$3,675	92%
Medica Choice	$3,707	93%
Itasca Med Care	$3,829	96%
Wps	$3,850 - $3,897	96%
UnitedHealthcare	$3,897 - $4,025	97%
Aetna	$3,943	99%
Healtheos	$3,990	100%
Advocare/Security Health	$4,025	101%
Freedom Blue Ppo	$4,025	101%
Healthpartners Care Msho / Mcr Adv	$4,025	101%
Imcare Msho Pcc Prime	$4,025	101%
Imcare Msho Ref Req	$4,025	101%
Medica Advantage Solutions	$4,025	101%
Medica Msho/Dual Solutions	$4,025	101%
Medica Prime Solution Group	$4,025	101%
Medicare (plans)	$4,025	101%
Nd Va Administration	$4,025	101%
Platinum Blue/Vantage Blue	$4,025	101%
Primewest Msho	$4,025	101%
Secure Blue Msho	$4,025	101%
Ubh Cost Plan	$4,025	101%
Ubh Msho	$4,025	101%
Ucare Msho	$4,025	101%

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 $2,978.
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 Essentia Health St Marys - Detroit Lakes 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.