CMS Price Transparency Data

Breast lump removal

Facility: Ochsner Lafayette General Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $550
Cash Discount Price: $848
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Ochsner Lafayette General Medical Center is $550. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $848. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.14x the Medicare baseline. Located in 1214 Coolidge Avenue, Lafayette, LA.

Cash / Self-Pay

$848

Average discount available for prompt cash payment at this facility.

Insurance Median

$550

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: $848 (21%)

Insurance Median: $550 (14%)

Cash: $848 (21% of Medicare)

Ins. Median: $550 (14% 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
Aetna	$281 - $3,843	7%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$281 - $550	7%
Healthy Blue (Healthy Louisiana)	$281 - $550	7%
Humana	$281 - $3,484	7%
Louisiana Healthcare Connections (Healthy Louisiana)	$281 - $550	7%
UnitedHealthcare	$281 - $4,698	7%
Verity Commercial And First Choice Network	$359 - $3,494	9%
Blue Cross Blue Shield	$391 - $6,851	10%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$391 - $3,484	10%
Medicare (plans)	$391 - $3,484	10%
Ochsner Health Plan	$391 - $3,484	10%
Wellcare Of Louisiana	$391 - $3,658	10%
Tricare	$400 - $3,484	10%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$403 - $3,585	10%
Zelis	$615 - $3,882	15%
Cigna	$795 - $3,484	20%

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 $848.
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 Ochsner Lafayette General Medical Center 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.