CMS Price Transparency Data

Breast lump removal

Facility: Ochsner LSU Health Monroe

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,420
Cash Discount Price: $4,066
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Ochsner LSU Health Monroe is $3,420. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,066. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.85x the Medicare baseline. Located in 4864 Jackson Street, Monroe, LA.

Cash / Self-Pay

$4,066

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,420

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: $4,066 (102%)

Insurance Median: $3,420 (85%)

Cash: $4,066 (102% of Medicare)

Ins. Median: $3,420 (85% 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	$550 - $5,221	14%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$550 - $825	14%
Healthy Blue (Formerly Amerigroup Louisiana Inc.)	$550 - $825	14%
Humana	$550 - $5,221	14%
Louisiana Healthcare Connections (Healthy Louisiana)	$550 - $825	14%
UnitedHealthcare	$550 - $5,221	14%
Cigna	$1,328 - $1,992	33%
Multiplan/Phcs/American Lifecare	$1,378 - $2,067	34%
First Health Network	$1,743 - $2,614	44%
(Healthy Louisiana) And Healthy Blue Dual Advantage (Hmo-D-Snp)	$3,481 - $5,221	87%
Blue Cross Blue Shield	$3,481 - $8,198	87%
Medicare (plans)	$3,481 - $5,221	87%
Verity Health Network – Lsu First Choice	$3,713 - $7,426	93%
Vantage Health Plan - Commercial	$5,743 - $8,614	144%
Zelis	$6,127 - $9,190	153%
Usa Managed Care Network	$6,630 - $13,260	166%
Healthcomp Ppo (Formerly Gilsbar 360	$8,701 - $13,052	218%

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 $4,066.
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 LSU Health Monroe 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.