CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: University McDuffie County Regional Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $171
Cash Discount Price: $118
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at University McDuffie County Regional Medical Center is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.80x the Medicare baseline. Located in 2460 Washington Road, Thomson, GA.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $118 (124%)

Insurance Median: $171 (180%)

Cash: $118 (124% of Medicare)

Ins. Median: $171 (180% 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
Medicaid / KanCare	$63 - $67	66%
Alliant Health Plans Of Georgia [10952]	$144 - $147	151%
Alliant Solocare [11101]	$144 - $147	151%
UnitedHealthcare	$152 - $241	160%
Medcost [10966]	$155 - $159	163%
Multiplan [10600]	$171 - $175	180%
Phcs [10601]	$171	180%
Cigna	$233 - $239	245%
Industry Buying Group [10840]	$252 - $259	265%
First Health [10303]	$330 - $338	347%
Kaiser [10500]	$330 - $338	347%
Aetna	$341 - $350	358%
Novanet [10819]	$349 - $358	367%

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 $118.
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 University McDuffie County Regional Medical 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.