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CMS Price Transparency Data Hospital file updated: 2026-03-04

Breast lump removal

Facility: Sanford Usd Medical Center

Billing Code: 19120 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Near Fair BaseRate Benchmark
$4,084Fair BaseRate (0.97× Market)
Position vs. 1.00× Fair Price3% Below Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $3,944 compared to the $4,084 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star Rating5/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score96/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

5-Star CMS clinical quality rating paired with 0.97× fair market pricing.

The BaseRate · fair price high confidence
A fair price for this
$4,084
about 1.0× the $4,000 Medicare rate · typically $3,422–$4,851
modeled estimate · not a bill or quote
What this hospital charges insurers
$3,944
About the fair price
about $140 under the fair price · 1.0× Medicare
Medicare pays $4,000 Fair price $4,084 This hospital $3,944

How we calculate the fair BaseRate →

How this hospital compares to other SD hospitals

A typical price — 2 charge more and 4 charge less, among the 8 SD hospitals compared.

Cheapest $441 Priciest $4,293

Black dot = this hospital, among the 8 SD hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $4,084 (about 1.0× the $4,000 Medicare rate). Sanford Usd Medical Center charges insurers about $3,944 — about the fair price. Located in Sioux Falls, SD.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

UnitedHealthcareBlue Cross Blue ShieldAetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $3,944 99%
Blue Cross Blue Shieldmajor $1,689 - $7,191 42%
Aetnamajor $3,944 99%
HealthPartners $3,944 99%
Sanford Health Plan $421 - $3,638 11%
UCare $3,906 - $3,995 98%
+ 1 smaller / regional plan $3,995 - $4,021
Government programs also on file: Medicare.

Self-Pay How to get the cash price

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Facility Profile & Credentials

  • Address: 1305 W 18Th St Post Office Box 5039, Sioux Falls, SD 57117
  • CMS Rating: 5 / 5 Stars
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals

Other Procedures at Sanford Usd Medical Center

Compare: Breast lump removal at other SD hospitals

Insurance negotiated median for the same procedure, sorted lowest first.

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Sanford Usd Medical Center (Zero PHI Required)

CMS CCN: 430027
CPT 19120
Fair BaseRate™ $4,084
Medicare Rate $4,000
Self-Pay Cash Request Quote
Insurer Median $3,944
Pre-filled with Sanford Usd Medical Center’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $3,436 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $3,436

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $3,436).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Sanford Usd Medical Center's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$5,382 Above Fair BaseRate

Negotiate Toward $4,084 Fair BaseRate ($4,000 Medicare)

Your bill ($9,466) is $5,382 above the denoised Fair BaseRate ($4,084) and 2.4× the $4,000 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall5/5 Stars (5/5)

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 430027

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 430027) ↗ CMS HCRIS Cost Reports ↗
Published MRF File460227855_sanford-usd-medical-center_standardcharges.csv
Publication / Vintage2026-03-04 · 960.70 MB
Validated Rate Rows10,529,954 (CMS v3.0.0)
File Integrity Digest2c94d6436b2e60819b7d…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy