CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Spanish Peaks Regional Health Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $138
Cash Discount Price: $146
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Spanish Peaks Regional Health Center is $138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.45x the Medicare baseline. Located in 23500 Us Highway 160, Walsenburg, CO.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$138

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: $146 (153%)

Insurance Median: $138 (145%)

Cash: $146 (153% of Medicare)

Ins. Median: $138 (145% 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
Devoted Health Mcr - All Plans	$51 - $315	54%
UnitedHealthcare	$60 - $142	63%
Apostrophe - All Plans	$75 - $138	79%
Blue Cross Blue Shield	$75 - $138	79%
Cofinity - All Plans	$75 - $141	79%
Connect For Health - All Plans	$75 - $142	79%
Friday Hp Chp - All Plans	$75 - $138	79%
Prov Ntwrk Of America - All Plans	$81 - $138	85%
Rmhp - All Plans	$87 - $142	91%
Kaiser Ppo - All Other Plans	$102 - $138	107%
Cigna	$138 - $154	145%
Multiplan Phcs - All Plans	$145 - $154	152%
Kaiser Ppo Mcr	$153	161%
Beacon Health Op Only-All Plans	$171	180%
Humana	$300	315%
Medicare (plans)	$300	315%

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 $146.
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 Spanish Peaks Regional Health 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.