CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Claiborne Memorial Medical Center
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $154
- Cash Discount Price: $202
- vs. Medicare Baseline: 1.62x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Claiborne Memorial Medical Center is $154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $202. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.62x the Medicare baseline. Located in 620 East College Street, Homer, LA.
Cash / Self-Pay
$202
Average discount available for prompt cash payment at this facility.
Insurance Median
$154
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: $202 (212%)
Insurance Median: $154 (162%)
Cash: $202 (212% of Medicare)
Ins. Median: $154 (162% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $38 - $162 | 40% |
| Amerihealth Caritas La | $38 - $107 | 40% |
| Community Health Solution | $38 - $107 | 40% |
| Correctcare Intergrated | $38 - $107 | 40% |
| Healthy Blue | $38 - $107 | 40% |
| Humana | $38 - $250 | 40% |
| Louisiana Hc Connections | $38 - $107 | 40% |
| Magellan Services | $38 - $107 | 40% |
| Medicaid / KanCare | $38 - $107 | 40% |
| UnitedHealthcare | $38 - $107 | 40% |
| Arcadian Community Mcr Hm | $60 - $84 | 63% |
| Blue Cross Blue Shield | $60 - $238 | 63% |
| Champus | $60 - $84 | 63% |
| Champva | $60 - $84 | 63% |
| Cigna | $60 - $188 | 63% |
| Healthy Blue Dual Adv | $60 - $84 | 63% |
| Kaiser Foundation Health | $60 - $84 | 63% |
| Medicare (plans) | $60 - $84 | 63% |
| Peoples Health Network | $60 - $84 | 63% |
| Pyramid Claims Mcr Hmo | $60 - $84 | 63% |
| Sterling Connect 2 | $60 - $84 | 63% |
| Sterling Premier Mc Hmo | $60 - $84 | 63% |
| Superior Health Mcr Hmo | $60 - $84 | 63% |
| Tenet Mcr Hmo | $60 - $84 | 63% |
| Tricare | $60 - $84 | 63% |
| United Hc Mcr Hmo | $60 - $73 | 63% |
| Universal Hc Mcr Hmo | $60 - $84 | 63% |
| Us Dept Of Labor | $60 - $84 | 63% |
| Vantage Health Mcr Hmo | $60 - $84 | 63% |
| Windsor Sterling Mcr Hmo | $60 - $84 | 63% |
| Wps Mvh Vapc3 | $60 - $84 | 63% |
| Commercial Insurance | $62 - $250 | 65% |
| Meritain Health | $62 - $162 | 65% |
| Vantage Health Plan Inc | $64 - $74 | 67% |
| Sedgwick Claims Mgmt Serv | $68 - $225 | 71% |
| Workman'S Comp | $68 - $225 | 71% |
| Coventry Healthcare | $92 - $150 | 97% |
| Geha | $108 - $175 | 113% |
| Health Plus Of La | $108 - $188 | 113% |
| Apwu Healthplan | $116 - $188 | 122% |
| Great West Healthcare | $116 - $188 | 122% |
| Phcs | $123 - $200 | 129% |
| Ppo Plus | $123 - $200 | 129% |
| Aarp | $154 - $250 | 162% |
| Accordia National | $154 - $250 | 162% |
| Aflac | $154 - $250 | 162% |
| Alameda Alliance Forhealt | $154 - $250 | 162% |
| American Pioneer | $154 - $250 | 162% |
| Benefit Management | $154 - $250 | 162% |
| Benesys Inc | $154 - $250 | 162% |
| Business Guarantor | $154 - $250 | 162% |
| Chubb | $154 - $250 | 162% |
| Commercial Sr. Care | $154 - $250 | 162% |
| Employee Benefit Services | $154 - $250 | 162% |
| Family Life Insurance Co | $154 - $250 | 162% |
| Farm Bureau Insurance | $154 - $250 | 162% |
| Fiserv Health Benefit | $154 - $250 | 162% |
| Gmp | $154 - $250 | 162% |
| Group And Pension Admin | $154 - $250 | 162% |
| Group Resources | $154 - $250 | 162% |
| Haik Minvielle And Grubbs | $154 - $250 | 162% |
| Harrington Benefit Svs | $154 - $250 | 162% |
| Health Design Plus | $154 - $250 | 162% |
| Health Plan | $154 - $250 | 162% |
| Healthscope Benefits | $154 - $250 | 162% |
| Insurance Management Admi | $154 - $250 | 162% |
| Jefferson National | $154 - $250 | 162% |
| John Alden Health Ins | $154 - $250 | 162% |
| John Hancock | $154 - $250 | 162% |
| Liberty Mutual | $154 - $250 | 162% |
| Mailhandlers Benefit Plan | $154 - $250 | 162% |
| Manhattan Life Ins Co | $154 - $250 | 162% |
| Mega Life And Health | $154 - $250 | 162% |
| Msa Careguard | $154 - $250 | 162% |
| Mutual Of Omaha | $154 - $250 | 162% |
| Nalc Health Benefit Plan | $154 - $250 | 162% |
| Naphcare Inc. | $154 - $250 | 162% |
| New Era Life Ins Co | $154 - $250 | 162% |
| Physicians Mutual | $154 - $250 | 162% |
| Principal Financial Group | $154 - $250 | 162% |
| Prudential Healthcare | $154 - $250 | 162% |
| Self Pay | $154 - $250 | 162% |
| State Farm | $154 - $250 | 162% |
| State Farm Insurance | $154 - $250 | 162% |
| State Mutual Insurance Co | $154 - $250 | 162% |
| Sterling Investors Life | $154 - $250 | 162% |
| Tower Life | $154 - $250 | 162% |
| Transamerica Premier Ins | $154 - $250 | 162% |
| United American | $154 - $250 | 162% |
| United Comm Travelers | $154 - $250 | 162% |
| United Teachers | $154 - $250 | 162% |
| Usable Administrator | $154 - $250 | 162% |
| Visn 16 Cfu | $154 - $250 | 162% |
| Wausau Benefits | $154 - $250 | 162% |
| Webtpa | $154 - $250 | 162% |
| Wells Fargo | $154 - $250 | 162% |
| Woodmen Of The World | $154 - $250 | 162% |