CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: North Oaks Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $118
Cash Discount Price: $47
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at North Oaks Medical Center is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.24x the Medicare baseline. Located in 15790 Paul Vega Md Drive, Hammond, LA.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $47 (49%)

Insurance Median: $118 (124%)

Cash: $47 (49% of Medicare)

Ins. Median: $118 (124% 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
Mco Lhc	$38	40%
Aetna	$39 - $698	41%
Humana	$39 - $616	41%
Mco Hb	$39	41%
Mco Lacare Am	$39	41%
Medicaid / KanCare	$39	41%
UnitedHealthcare	$39 - $312	41%
Blue Cross Blue Shield	$46 - $47	48%
Tricare	$94 - $118	99%
Allwell	$118	124%
Blue Advantage	$118	124%
Champva	$118	124%
Healthy Blue Dual Advantage	$118	124%
Peoples Health	$118	124%
Vantage 65	$118	124%
Veterans Administration	$118	124%
Wellcare	$118	124%
Coventry	$534	561%
Verity Healthnet	$534	561%
Ppoplus Llc	$575	604%
Multiplan	$616	647%
Cigna	$649	682%

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 $47.
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 North Oaks Medical Center 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.