CMS Price Transparency Data

Breast lump removal

Facility: Dunes Surgical Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,293
Cash Discount Price: $5,834
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Dunes Surgical Hospital is $4,293. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,834. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.07x the Medicare baseline. Located in 600 N Sioux Point Road, Dakota Dunes, SD.

Cash / Self-Pay

$5,834

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,293

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: $5,834 (146%)

Insurance Median: $4,293 (107%)

Cash: $5,834 (146% of Medicare)

Ins. Median: $4,293 (107% 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
UnitedHealthcare	$427 - $5,216	11%
Blue Cross Blue Shield	$1,552	39%
Ne Total Care	$3,890	97%
Siouxland Pace	$3,890	97%
Ia Total Care	$3,967	99%
Wellpoint	$3,967	99%
Molina	$4,006	100%
Amerigroup	$4,022	101%
Cigna	$4,564	114%
Midlands Choice	$4,564	114%
Oscar	$4,629	116%
Avera Health Plans	$4,890	122%
Multiplan	$4,890	122%
Accountable Healthplan	$5,542	139%
Sanford Health Plan	$5,542	139%
Health Partners	$6,324	158%

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 $5,834.
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 Dunes Surgical Hospital 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.