CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Ochsner Choctaw General

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $161
Cash Discount Price: $195
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Ochsner Choctaw General is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $195. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.69x the Medicare baseline. Located in 401 Vanity Fair Lane, Po Box 618, Butler, AL.

Cash / Self-Pay

$195

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $195 (205%)

Insurance Median: $161 (169%)

Cash: $195 (205% of Medicare)

Ins. Median: $161 (169% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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
Blue Cross Blue Shield	$52	55%
Medicaid / KanCare	$55 - $57	58%
Cigna	$56 - $196	59%
Humana	$67 - $196	70%
Claritev D/B/A Multiplan/Phcs/American Life Care	$69 - $192	72%
Prime Health Services Ppo -Workers Comp	$81 - $204	85%
Cor Vel	$82 - $209	86%
Aetna	$84 - $166	88%
Zelis	$89 - $192	93%
UnitedHealthcare	$90 - $196	95%
Prime Health Services Ppo	$94 - $205	99%
Magnolia Health Plan – Wellcare By All Well Of Mississippi	$115 - $196	121%
Medicare (plans)	$115 - $225	121%
Ambetter / Centene	$116	122%
Shared Health Mississippi	$121 - $206	127%
Select Administrative Services Network	$127 - $179	133%
Primewell Health Services Commercial Exchange Plan	$131 - $172	138%
Primewell Health Services – Commercial	$131 - $172	138%

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 $195.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Ochsner Choctaw General is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
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.