CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Methodist Jennie Edmundson

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $245
Cash Discount Price: $139
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Methodist Jennie Edmundson is $245. 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 2.57x the Medicare baseline. Located in 933 East Pierce Street, Council Bluffs, IA.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$245

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: $245 (257%)

Cash: $139 (146% of Medicare)

Ins. Median: $245 (257% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 257% of the Medicare baseline (a markup of 157%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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)	$89 - $288	93%
Medica	$149 - $260	157%
Ne Furniture Mart	$161 - $346	169%
Aetna	$164 - $357	172%
Elite Choice - Mje	$170	179%
Medica Choice	$175 - $288	184%
Ambetter / Centene	$185	194%
Blue Cross Blue Shield	$195 - $491	205%
UnitedHealthcare	$210 - $979	221%
Midlands Choice	$214 - $325	225%
Wellmark	$422 - $464	443%

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 Methodist Jennie Edmundson 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.