CMS Price Transparency Data

Breast lump removal

Facility: Ochsner Medical Center - Baton Rouge

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,553
Cash Discount Price: $2,727
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Ochsner Medical Center - Baton Rouge is $4,553. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,727. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.14x the Medicare baseline. Located in 17000 Medical Center Dr, Baton Rouge, LA.

Cash / Self-Pay

$2,727

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,553

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: $2,727 (68%)

Insurance Median: $4,553 (114%)

Cash: $2,727 (68% of Medicare)

Ins. Median: $4,553 (114% 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
Humana	$550 - $5,281	14%
UnitedHealthcare	$550 - $9,164	14%
Healthy Blue (Healthy Louisiana)	$561 - $842	14%
Louisiana Healthcare Connections (Healthy Louisiana)	$561 - $842	14%
Aetna	$567 - $7,317	14%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$567 - $850	14%
Claritev D/B/A Multiplan/Phcs/American Life Care	$965 - $1,448	24%
Healthcomp & Personify Health (Formerly Gilsbar)	$2,557 - $5,113	64%
Medicaid / KanCare	$2,824 - $4,236	71%
Cigna	$3,035 - $4,552	76%
Louisiana Workers' Compensation Corporation (Lwcc)	$3,196 - $6,392	80%
Mississippi Physicians Care Network	$3,196 - $6,392	80%
First Health Network	$3,409 - $6,818	85%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$3,521 - $5,281	88%
Blue Cross Blue Shield	$3,521 - $9,387	88%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$3,521 - $5,281	88%
Medicare (plans)	$3,521 - $5,281	88%
Ochsner Health Plan	$3,521 - $5,281	88%
Tricare	$3,521 - $5,281	88%
Prime Health Services Ppo	$3,622 - $7,244	91%
Usa Managed Care Network	$3,622 - $7,244	91%

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 $2,727.
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 Medical Center - Baton Rouge 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.