CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: The Medical Center of Aurora & South Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $41
Cash Discount Price: $71
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at The Medical Center of Aurora & South Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.43x the Medicare baseline. Located in 1501 S Potomac St, Aurora, CO.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $71 (75%)

Insurance Median: $41 (43%)

Cash: $71 (75% of Medicare)

Ins. Median: $41 (43% 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
Vail Health	$11	12%
Kaiser	$14 - $25	15%
United	$15 - $32	16%
Aetna	$21 - $37	22%
Bright Health	$21	22%
Colorado Program For Children With Special Needs	$30	32%
Cigna	$35 - $45	37%
Western Plains Community Health	$46	48%
Multiplan	$50 - $64	53%
Northcare	$50	53%
Physician Health Partners	$50	53%
Blue Cross Blue Shield	$53	56%
Pinnacol Workers Comp	$53	56%
Medical Development International	$57	60%
Triwest Health Alliance	$57	60%
Prime Health	$64	67%

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 $71.
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 The Medical Center of Aurora & South 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.