CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Southeast Iowa Regional Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $126
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.32x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Southeast Iowa Regional Medical Center is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.32x the Medicare baseline. Located in 1221 South Gear Avenue, West Burlington, IA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$126

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%)
Insurance Median: $126 (132%)
Ins. Median: $126 (132% 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.

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 $26 - $46 27%
United Behavioral Health Ma $53 56%
United Behavioral Health Rn $53 - $66 56%
Aetna $58 - $171 61%
United Behavioral Health Phd $60 63%
Plain Church $68 - $168 71%
American Healthplan Of Iowa - Midlevel $70 74%
United Behavioral Health Md $70 - $78 74%
Humana $85 89%
Absolute Solutions $94 - $174 99%
First Agency $94 - $174 99%
Multiplan $94 - $174 99%
American Healthplan Of Iowa - Md $98 103%
Henderson County $99 - $183 104%
Elap $110 - $157 116%
Blue Cross Blue Shield $130 137%
UnitedHealthcare $131 138%
Midlands Choice $133 - $232 140%
Wellpoint (Amerigroup) $144 151%
Immugrun $163 171%
Brighton Amish Church $168 176%
6 Degree $206 216%
Geha $240 252%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1221 South Gear Avenue, West Burlington, IA 52655
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals