CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Ochsner St Martin Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $76
Cash Discount Price: $83
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Ochsner St Martin Hospital is $76. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.80x the Medicare baseline. Located in 210 Champagne Boulevard, Breaux Bridge, LA.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$76

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: $83 (87%)

Insurance Median: $76 (80%)

Cash: $83 (87% of Medicare)

Ins. Median: $76 (80% 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
Verity Commercial And First Choice Network	$32 - $121	34%
Aetna	$38 - $315	40%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$38 - $143	40%
Healthy Blue (Healthy Louisiana)	$38 - $143	40%
Humana	$38 - $218	40%
Louisiana Healthcare Connections (Healthy Louisiana)	$38 - $143	40%
UnitedHealthcare	$38 - $260	40%
Blue Cross Blue Shield	$61 - $264	64%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$61 - $218	64%
Medicare (plans)	$61 - $218	64%
Ochsner Health Plan	$61 - $218	64%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$63 - $224	66%
Tricare	$63 - $88	66%
Cigna	$68 - $90	71%
Wellcare Of Louisiana	$76 - $218	80%
Zelis	$242	254%

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 $83.
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 St Martin Hospital 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.