CMS Price Transparency Data

Breast lump removal

Facility: Abbeville General Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,042
Cash Discount Price: $613
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Abbeville General Hospital is $1,042. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $613. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.26x the Medicare baseline. Located in 118 N Hospital Dr, Abbeville, LA.

Cash / Self-Pay

$613

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,042

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: $613 (15%)

Insurance Median: $1,042 (26%)

Cash: $613 (15% of Medicare)

Ins. Median: $1,042 (26% 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
Ppo Plus Professional	$470	12%
Blue Cross Blue Shield	$524 - $5,834	13%
Cigna	$608	15%
Self Pay	$613	15%
Humana	$797 - $8,864	20%
Aetna	$858 - $3,489	21%
Triwest Healthcare Alliance	$915	23%
Gilsbar Ppo	$919 - $950	23%
Ppo Plus	$919	23%
United Behavioral Health Inc	$919	23%
Verity Healthnet National	$919	23%
American Lifecare (Phcs)	$950 - $981	24%
Guardian Resources	$981	25%
UnitedHealthcare	$981 - $3,545	25%
Coventry Company	$1,042	26%
Galaxy Health Network	$1,042	26%
Usa Managed Care	$1,042	26%
Health Payors Organization	$1,103	28%
Miscellaneous Insurance	$1,226	31%
Wellcare Of Louisiana	$1,226	31%
Vantage Health Plan	$2,206 - $7,501	55%
Office Of Group Benefits	$3,437	86%
Healthy Blue	$3,489	87%
People'S Health	$3,489	87%
Medicare (plans)	$3,545	89%
Sierra Health And Life Insurance	$3,545	89%
Sterling Life Insurance Company	$3,545	89%
Med-Comp Usa Inc	$4,886	122%

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 $613.
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 Abbeville General 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.