CMS Price Transparency Data

Breast lump removal

Facility: Ochsner St Anne General Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,945
Cash Discount Price: $2,423
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Ochsner St Anne General Hospital is $3,945. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,423. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.99x the Medicare baseline. Located in 4608 Highway 1, Raceland, LA.

Cash / Self-Pay

$2,423

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,945

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: $2,423 (61%)

Insurance Median: $3,945 (99%)

Cash: $2,423 (61% of Medicare)

Ins. Median: $3,945 (99% 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	$536 - $1,707	13%
UnitedHealthcare	$536 - $7,611	13%
Healthy Blue (Healthy Louisiana)	$546	14%
Louisiana Healthcare Connections (Healthy Louisiana)	$546	14%
Aetna	$552 - $3,945	14%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$552	14%
Tricare	$1,533 - $1,703	38%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$1,707	43%
Blue Cross Blue Shield	$1,707 - $7,042	43%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$1,707	43%
Medicare (plans)	$1,707	43%
Ochsner Health Plan	$1,707	43%
Medicaid / KanCare	$2,824	71%
Healthcomp & Personify Health (Formerly Gilsbar)	$4,130	103%
Louisiana Workers' Compensation Corporation (Lwcc)	$4,130	103%
Mississippi Physicians Care Network	$4,130	103%
Employers Health Network (Ehn)	$4,680	117%
First Health Network	$4,680	117%
Prime Health Services Ppo	$4,680	117%
Claritev D/B/A Multiplan/Phcs/American Life Care	$4,955	124%
Usa Managed Care Network	$4,955	124%
Zelis	$4,955	124%
Cigna	$5,269	132%

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 $2,423.
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 St Anne 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.