CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Ochsner St Martin Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $91
Cash Discount Price: $84
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Ochsner St Martin Hospital is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.67x the Medicare baseline. Located in 210 Champagne Boulevard, Breaux Bridge, LA.

Cash / Self-Pay

$84

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $84 (62%)

Insurance Median: $91 (67%)

Cash: $84 (62% of Medicare)

Ins. Median: $91 (67% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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	$41 - $384	30%
Aetna	$43 - $331	32%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$43 - $218	32%
Humana	$43 - $218	32%
Medicare (plans)	$43 - $218	32%
Ochsner Health Plan	$43 - $218	32%
UnitedHealthcare	$43 - $273	32%
Wellcare Of Louisiana	$43 - $218	32%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$44 - $224	32%
Verity Commercial And First Choice Network	$45 - $127	33%
Tricare	$49 - $121	36%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$57 - $143	42%
Healthy Blue (Healthy Louisiana)	$57 - $143	42%
Louisiana Healthcare Connections (Healthy Louisiana)	$57 - $143	42%
Cigna	$99 - $126	73%
Zelis	$136 - $255	100%

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 $84.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.