CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Memorial Hospital and Manor

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $187
Cash Discount Price: $139
vs. Medicare Baseline: 1.96x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Memorial Hospital and Manor is $187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.96x the Medicare baseline. Located in 1500 E Shotwell Street, Bainbridge, GA.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$187

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: $139 (146%)

Insurance Median: $187 (196%)

Cash: $139 (146% of Medicare)

Ins. Median: $187 (196% 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
Medicare (plans)	$63	66%
Amerigroup_Plan	$140 - $163	147%
Medicaid / KanCare	$140 - $163	147%
Peach_State_Health_Plan_Plan	$140 - $163	147%
Caresource_Plan	$147 - $171	154%
Blue Cross Blue Shield	$172 - $199	181%
Humana	$174 - $206	183%
Aetna	$176 - $232	185%
Uhc_Plan	$176 - $204	185%
Novanet_Plan	$178 - $206	187%
Cigna	$185 - $214	194%
Private_Healthcare_Systems_Plan	$190 - $219	200%
Multiplan_Plan	$201 - $232	211%
Corvel_Plan	$212 - $245	223%
Tnga_Plan	$450	473%

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 $139.
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 Memorial Hospital and Manor 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.