CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercyone Waterloo Medical Center
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $50
- Cash Discount Price: $616
- vs. Medicare Baseline: 0.53x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercyone Waterloo Medical Center is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $616. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.53x the Medicare baseline. Located in 3421 West Ninth Street, Waterloo, IA.
Cash / Self-Pay
$616
Average discount available for prompt cash payment at this facility.
Insurance Median
$50
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: $616 (647%)
Insurance Median: $50 (53%)
Cash: $616 (647% of Medicare)
Ins. Median: $50 (53% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Albany County Correctional Facility | $26 | 27% |
| Ambetter / Centene | $26 - $327 | 27% |
| Amish Mennonite | $26 | 27% |
| Ascension St. Vincent Public Safety Medical | $26 | 27% |
| Bcccp-Michigan | $26 | 27% |
| Bccp | $26 | 27% |
| Blue Cross Blue Shield | $26 - $207 | 27% |
| Bmc Healthnet | $26 | 27% |
| Breast Grant-Connecticut | $26 | 27% |
| Broward County Dept Of Health | $26 | 27% |
| California Health And Wellness | $26 | 27% |
| Can Community Health Inc | $26 | 27% |
| Cardinal Innovations Lme | $26 | 27% |
| Care Connections Of Northern Iowa | $26 | 27% |
| Care Oregon Ohp | $26 | 27% |
| Cencal Health Plan | $26 | 27% |
| Cenpatico | $26 | 27% |
| Chhuny | $26 | 27% |
| Childrens Comm Health Plan | $26 | 27% |
| Childrens Medical Services Title 19 | $26 | 27% |
| Cigna | $26 - $112 | 27% |
| City Of Philadelphia | $26 | 27% |
| Cmh Allegan County | $26 | 27% |
| Cmh Ausable Valley | $26 | 27% |
| Cmh Barry County | $26 | 27% |
| Cmh Bay-Arenac County | $26 | 27% |
| Cmh Berrien County | $26 | 27% |
| Cmh Cass County | $26 | 27% |
| Cmh Central Mi County | $26 | 27% |
| Cmh Clinton-Eaton-Ingham County | $26 | 27% |
| Cmh Detroit Wayne Integrated Health Network | $26 | 27% |
| Cmh Genesee County | $26 | 27% |
| Cmh Ionia County | $26 | 27% |
| Cmh Jackson County/Lifeways | $26 | 27% |
| Cmh Kalamazoo | $26 | 27% |
| Cmh Kent County | $26 | 27% |
| Cmh Lenawee County | $26 | 27% |
| Cmh Livingston County | $26 | 27% |
| Cmh Macomb | $26 | 27% |
| Cmh Misc | $26 | 27% |
| Cmh Monroe County | $26 | 27% |
| Cmh Montcalm County | $26 | 27% |
| Cmh Muskegon County | $26 | 27% |
| Cmh Newaygo County | $26 | 27% |
| Cmh North Country | $26 | 27% |
| Cmh Northern Lakes County | $26 | 27% |
| Cmh Oakland County | $26 | 27% |
| Cmh Ottawa County | $26 | 27% |
| Cmh Van Buren County | $26 | 27% |
| Cmh Washtenaw County | $26 | 27% |
| Cmh Wayne County/Carelink | $26 | 27% |
| Cmh Wayne Cty/Com Liv Svcs | $26 | 27% |
| Cmh West Mi County | $26 | 27% |
| Community Benefit Health | $26 | 27% |
| Community Care Behavorial Health | $26 | 27% |
| Community Care Partners | $26 | 27% |
| Community Health Choice | $26 | 27% |
| Connections Csp | $26 | 27% |
| County Coroner | $26 | 27% |
| County Funding Generic | $26 | 27% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $26 | 27% |
| Dean Wi Badgercare | $26 | 27% |
| Delaware County Department Of Health | $26 | 27% |
| Delaware First Health | $26 | 27% |
| Delta Dental Nj | $26 | 27% |
| Dph Tb Program | $26 | 27% |
| Dscc | $26 | 27% |
| Eastpointe Lme | $26 | 27% |
| Family Health Network | $26 | 27% |
| Freedom First Healthcare | $26 | 27% |
| Fresno County Ccs | $26 | 27% |
| Ghc Scw Wi Badgercare | $26 | 27% |
| Harbor Health | $26 | 27% |
| Health Safety Net | $26 | 27% |
| Healthy Blue Ne | $26 | 27% |
| Hennepin Health | $26 | 27% |
| Humana | $26 - $74 | 27% |
| Id County Ada | $26 | 27% |
| Id County Canyon | $26 | 27% |
| Id County Cat Fund | $26 | 27% |
| Id County Other | $26 | 27% |
| Id County Payette | $26 | 27% |
| Idaho Dept Health And Wellfare | $26 | 27% |
| Idaho Womens Health Check | $26 | 27% |
| Indiana Breast Cervical Cancer | $26 | 27% |
| Inland Empire Health Plan | $26 | 27% |
| Intercommunity Health Ohp | $26 | 27% |
| Jai Medical System | $26 | 27% |
| Kern Family Health Plan | $26 | 27% |
| Keystone First | $26 | 27% |
| Keystone First Chip | $26 | 27% |
| La Care Health Plan | $26 | 27% |
| Lakeland Care Inc | $26 | 27% |
| Managed Health Services - Indiana | $26 | 27% |
| Maryland Breast & Cervical Program | $26 | 27% |
| Maryland Healthy Smiles - Scion Dental | $26 | 27% |
| Maryland Physicians Care | $26 | 27% |
| Massachusetts Behavioral Health Partnership | $26 | 27% |
| Mdwise | $26 | 27% |
| Medi-Cal | $26 | 27% |
| Medi-Cal Healthnet | $26 | 27% |
| Medicaid / KanCare | $26 - $196 | 27% |
| Medstar Dc Healthy Family | $26 | 27% |
| Medstar Md Health Choice | $26 | 27% |
| Mo Home State Health Plan | $26 | 27% |
| Molina Centennial Care | $26 | 27% |
| Nascentia Health Options | $26 | 27% |
| New York Cancer Services Program | $26 | 27% |
| Nextlevel Health | $26 | 27% |
| Oregon Screenwise | $26 | 27% |
| Pace Of Southwest Michigan | $26 - $46 | 27% |
| Paramount Advantage | $26 | 27% |
| Parkland Community Health Plan | $26 | 27% |
| Partners Behavioral Lme | $26 | 27% |
| Peach State Healthplan | $26 | 27% |
| Philadelphia County Funding | $26 | 27% |
| Presbyterian Centennial Care | $26 | 27% |
| Prestige Health Choice | $26 | 27% |
| Priority Partners | $26 | 27% |
| Robert F Sing Program | $26 | 27% |
| Rx 340B Pass Along | $26 | 27% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $26 | 27% |
| Rx Medi-Cal | $26 | 27% |
| Rx Meridian Rx | $26 | 27% |
| Ryan White Florida Mssrp | $26 | 27% |
| Sandhills Center Lme | $26 | 27% |
| Screening For Life | $26 | 27% |
| St Joseph County Hlth Dpt | $26 | 27% |
| Sunshine State Health Plan | $26 | 27% |
| Superior Health | $26 | 27% |
| Tenncare | $26 | 27% |
| Texas Children'S Health Plan | $26 | 27% |
| Trillium Community Ohp | $26 | 27% |
| Tufts Health Public Plans | $26 | 27% |
| UnitedHealthcare | $26 - $93 | 27% |
| Vaya Health Lme | $26 | 27% |
| Washtenaw Health Plan | $26 | 27% |
| Wellsense Health Plan | $26 | 27% |
| Wi Womens Wellness | $26 | 27% |
| Iowa Total Care | $27 - $194 | 28% |
| Wellpoint | $27 | 28% |
| Aetna | $45 - $141 | 47% |
| Align Senior Care | $46 | 48% |
| Ally Align Care Adv | $46 | 48% |
| American Health Advantage Of Idaho | $46 | 48% |
| Aurora Special Needs | $46 | 48% |
| Blue Care Network Advantage | $46 | 48% |
| Blue Shield - De (Highmark) Medciare Advantage | $46 | 48% |
| Care Dimensions | $46 | 48% |
| Care Improvement Plus | $46 | 48% |
| Care Resources Pace | $46 | 48% |
| Careplus Health Plans | $46 | 48% |
| Cca - Zing Health | $46 | 48% |
| Cca Senior Care Options | $46 | 48% |
| Central Valley Medical Services Corp Pace | $46 | 48% |
| Champion Health Plan Mcr Advantage | $46 | 48% |
| Clear Spring Health | $46 | 48% |
| Clover Health | $46 | 48% |
| Commonwealth Care Alliance | $46 | 48% |
| Community Pace At Home | $46 | 48% |
| Eddy Senior Care-Pace | $46 | 48% |
| Eddy Seniorcare Pace | $46 | 48% |
| Elementcare | $46 | 48% |
| Evercare | $46 | 48% |
| Everence | $46 | 48% |
| Gateway Health Plan | $46 | 48% |
| Genesys Pace Of Genesee County | $46 | 48% |
| Georgia Health Advantage | $46 | 48% |
| Gold Advantage | $46 | 48% |
| Gpa Croell Redi Mix | $46 | 48% |
| Health America Advantra | $46 | 48% |
| Highmark Health Options Dual Plan | $46 | 48% |
| Hope Select Pace | $46 | 48% |
| Horizon Nj Total Care | $46 | 48% |
| Hudson Headwaters Pace | $46 | 48% |
| Huron Valley Pace | $46 | 48% |
| Innovative Integrated Health Community Plans | $46 | 48% |
| Johns Hopkins Advantage Md | $46 | 48% |
| Lasso Healthcare Msa | $46 | 48% |
| Life St Marys Pace | $46 | 48% |
| Lifecircles Pace | $46 | 48% |
| Longevity Health Plan | $46 | 48% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $46 | 48% |
| Martins Point Generations Advantage | $46 | 48% |
| Mass General Brigham Mcr Adv | $46 | 48% |
| Medicare (plans) | $46 - $56 | 48% |
| Medipak Advantage | $46 | 48% |
| Mercy Life | $46 | 48% |
| Mercyone Cedar Valley | $46 | 48% |
| Meridian Complete | $46 | 48% |
| Michigan Complete Health | $46 | 48% |
| Nascentia Health Plus | $46 | 48% |
| New Centry Health Careplus | $46 | 48% |
| Osu Prime Care Advantage | $46 | 48% |
| Pace Cny | $46 | 48% |
| Pace Iowa Immanuel Pathways | $46 | 48% |
| Pace Southeast | $46 | 48% |
| Pace-Trinity Health | $46 | 48% |
| Peak Pace Solutions | $46 | 48% |
| Perennial Advantage | $46 | 48% |
| Preferred Care Partners | $46 | 48% |
| Presbyterian Senior Plan | $46 | 48% |
| Provider Partners Health Plan Of Illinois | $46 | 48% |
| Provider Partners Health Plan Of Indiana | $46 | 48% |
| Pruitthealth Premier | $46 | 48% |
| Reliance Community Care Partners Care Resources Pace | $46 | 48% |
| Rx Allwin | $46 | 48% |
| Rx Grane Grnmedd | $46 | 48% |
| Rx Retiree Rx Care | $46 | 48% |
| Scan Health Plan Mcr Ipa Meritage Oon | $46 | 48% |
| Secure Horizons Ma Pffs | $46 | 48% |
| Serenity Pace | $46 | 48% |
| Siouxland Pace | $46 | 48% |
| Solis Health Plans | $46 | 48% |
| Sunnyview-Pace Finance Dept | $46 | 48% |
| Texan Plus | $46 | 48% |
| The Health Plan | $46 | 48% |
| Thome Pace | $46 | 48% |
| Todays Options | $46 | 48% |
| Tribute Health Plans | $46 | 48% |
| Um Health Advantage | $46 | 48% |
| Union Health Service | $46 | 48% |
| Veterans Administration | $46 | 48% |
| Welbe Health | $46 | 48% |
| Wellmed | $46 | 48% |
| American Health Plan | $48 | 50% |
| Iowa Health Advantage | $48 | 50% |
| Nebraska Total Care | $50 | 53% |
| Champva | $51 | 54% |
| Tricare | $51 | 54% |
| Triwest Health Alliance | $51 | 54% |
| Us Family Health Plan | $51 | 54% |
| Veterans Eval Services | $51 | 54% |
| Wc Corvel | $52 | 55% |
| Amps | $59 | 62% |
| Iowa Dept Of Public Health | $60 | 63% |
| Amish Hospital Aid | $62 - $73 | 65% |
| Naphcare | $63 | 66% |
| Naphcare Correctional | $63 | 66% |
| Geha | $67 - $93 | 70% |
| Avera | $71 | 75% |
| Medical Associates | $78 | 82% |
| Preferred Health Choice | $78 | 82% |
| Sanford Health Plan | $78 | 82% |
| Bcn Domestic | $79 - $207 | 83% |
| Blue Benefit Administrators Of Massachusetts | $79 - $207 | 83% |
| Blue Care Network | $79 - $207 | 83% |
| Blue Distinction Transplant | $79 - $207 | 83% |
| Blue Shield - Ca | $79 - $207 | 83% |
| Blue Shield - Id (Regence) | $79 - $207 | 83% |
| Blue Shield - Ny Highmark Northeastern | $79 - $207 | 83% |
| Blue Shield - Ny Highmark Western | $79 - $207 | 83% |
| Blue Shield - Pa (Highmark) | $79 - $207 | 83% |
| Blue Shield - Wa (Regence) | $79 - $207 | 83% |
| Health Choices | $79 - $112 | 83% |
| Kaiser Domestic | $79 - $207 | 83% |
| Pre-Employment | $79 - $207 | 83% |
| Wc Domestic | $79 - $207 | 83% |
| Ucare | $83 | 87% |
| Lucent Health | $84 | 88% |
| Oscar | $84 - $86 | 88% |
| Health Partners | $86 - $104 | 90% |
| Health Smart | $86 | 90% |
| Usa Managed Care | $90 | 95% |
| Centivo | $91 - $107 | 96% |
| Newton Correctional Facility | $92 | 97% |
| Claimdoc | $97 - $110 | 102% |
| The Alliance | $98 | 103% |
| Stephenson Cty Health | $100 | 105% |
| Meritain | $103 | 108% |
| Global Excel | $105 | 110% |
| Genex Wc | $106 | 111% |
| Velocity | $109 | 115% |
| Nova | $110 | 116% |
| Allied Benefit Systems | $112 | 118% |
| Auxiant | $112 | 118% |
| First Choice Health | $112 | 118% |
| Group Administrators | $112 | 118% |
| Midlands | $112 | 118% |
| Midlands Choice | $112 | 118% |
| Preferred One | $112 | 118% |
| Wc Align Network | $113 | 119% |
| Wc Praxis Health Network | $120 | 126% |
| Wc Reny Company | $123 | 129% |
| Wc Velocity | $123 | 129% |
| Auto Velocity | $127 | 133% |
| Wc O'Hara Corp | $127 | 133% |
| Multiplan | $132 | 139% |
| Andrie Inc | $141 | 148% |
| East Greenbush Central School District | $141 | 148% |
| Healthsmart Workers Comp | $141 | 148% |
| Jag Source | $141 | 148% |
| New York State Insurance Fund | $141 | 148% |
| Njm Insurance Group | $141 | 148% |
| Quiktrip | $141 | 148% |
| Rx Heatlhcomp | $141 | 148% |
| Rx Restat | $141 | 148% |
| Rx Saif Opdp Wc | $141 | 148% |
| Rx Worker'S Comp | $141 | 148% |
| Wc Accident Fund | $141 | 148% |
| Wc Ace | $141 | 148% |
| Wc Acs Federal Employees | $141 | 148% |
| Wc Acuity | $141 | 148% |
| Wc Advantage | $141 | 148% |
| Wc Aegis | $141 | 148% |
| Wc Aig | $141 | 148% |
| Wc Aims | $141 | 148% |
| Wc Alaska National Ins | $141 | 148% |
| Wc Allied | $141 | 148% |
| Wc Am Trust N America | $141 | 148% |
| Wc American Claims Mgmt | $141 | 148% |
| Wc Amerisure | $141 | 148% |
| Wc Amtrust | $141 | 148% |
| Wc Asu Risk Mgt | $141 | 148% |
| Wc Benetech | $141 | 148% |
| Wc Berkley Admin | $141 | 148% |
| Wc Broadspire | $141 | 148% |
| Wc Broward County | $141 | 148% |
| Wc Bunch & Associates | $141 | 148% |
| Wc California State Comp Ins | $141 | 148% |
| Wc California State Ins Fund | $141 | 148% |
| Wc Capitol Area Health Consortium | $141 | 148% |
| Wc Ccmsi | $141 | 148% |
| Wc Chartis | $141 | 148% |
| Wc Chubb | $141 | 148% |
| Wc Cirma | $141 | 148% |
| Wc City Of Albany | $141 | 148% |
| Wc City Of Sioux City | $141 | 148% |
| Wc Claims Mgmt Inc | $141 | 148% |
| Wc Cna | $141 | 148% |
| Wc Comp One Admin C/O Manageability | $141 | 148% |
| Wc Compone Admin | $141 | 148% |
| Wc Ct Healthcare Trust | $141 | 148% |
| Wc Donegal Insurance Group | $141 | 148% |
| Wc Emc Insurance Company | $141 | 148% |
| Wc Employee Mutual | $141 | 148% |
| Wc Enablecomp | $141 | 148% |
| Wc Encore Health Network | $141 | 148% |
| Wc Erie | $141 | 148% |
| Wc Esis | $141 | 148% |
| Wc Evolutions | $141 | 148% |
| Wc Fcci | $141 | 148% |
| Wc Fed Ex | $141 | 148% |
| Wc Federal Black Lung | $141 | 148% |
| Wc Federated | $141 | 148% |
| Wc Finley Occupational Health | $141 | 148% |
| Wc First Agency/Occunet | $141 | 148% |
| Wc Ford Motor | $141 | 148% |
| Wc Fresno Unified Emp | $141 | 148% |
| Wc Gallagher Bassett | $141 | 148% |
| Wc General Motors | $141 | 148% |
| Wc Generic | $141 | 148% |
| Wc Genex Care For Ohio | $141 | 148% |
| Wc Great West Casualty | $141 | 148% |
| Wc Guarantee Insurance | $141 | 148% |
| Wc Guard Insurance Company | $141 | 148% |
| Wc Hab | $141 | 148% |
| Wc Hartford | $141 | 148% |
| Wc Hastings | $141 | 148% |
| Wc Health Management | $141 | 148% |
| Wc Heritage Summit | $141 | 148% |
| Wc Hireright | $141 | 148% |
| Wc Horizon | $141 | 148% |
| Wc Icw Group | $141 | 148% |
| Wc Idaho State Ins Fund | $141 | 148% |
| Wc Intercare Insurance | $141 | 148% |
| Wc Intermountain | $141 | 148% |
| Wc Johns Eastern | $141 | 148% |
| Wc Kemberton | $141 | 148% |
| Wc Key Ins & Benefit Solutions | $141 | 148% |
| Wc Liberty Mutual | $141 | 148% |
| Wc Mac Risk Management | $141 | 148% |
| Wc Massachusetts | $141 | 148% |
| Wc Mdia | $141 | 148% |
| Wc Meadowbrook Claim | $141 | 148% |
| Wc Medical Administrators | $141 | 148% |
| Wc Meijers | $141 | 148% |
| Wc Memic | $141 | 148% |
| Wc Mercy Workcare | $141 | 148% |
| Wc Michigan | $141 | 148% |
| Wc Michigan Millers Mutual | $141 | 148% |
| Wc Mitchell Frankenmuth | $141 | 148% |
| Wc Mra | $141 | 148% |
| Wc Nationwide | $141 | 148% |
| Wc Nca Comp | $141 | 148% |
| Wc New York | $141 | 148% |
| Wc New York Special Funds | $141 | 148% |
| Wc North American Rishces | $141 | 148% |
| Wc Northeast Health | $141 | 148% |
| Wc Notre Dame | $141 | 148% |
| Wc Novanet | $141 | 148% |
| Wc Occ Health Allen | $141 | 148% |
| Wc Ohio Bureau | $141 | 148% |
| Wc One Call Medical | $141 | 148% |
| Wc Paradigm | $141 | 148% |
| Wc Peerless | $141 | 148% |
| Wc Pma | $141 | 148% |
| Wc Price Chopper | $141 | 148% |
| Wc Procura Management | $141 | 148% |
| Wc Qualcare | $141 | 148% |
| Wc Quiktrip | $141 | 148% |
| Wc Rev Claims | $141 | 148% |
| Wc Risico | $141 | 148% |
| Wc Rural Mutual | $141 | 148% |
| Wc Saif Oregon | $141 | 148% |
| Wc Secura | $141 | 148% |
| Wc Sedgwick | $141 | 148% |
| Wc Sentry | $141 | 148% |
| Wc Sheakley Unicomp | $141 | 148% |
| Wc Smile Lodge | $141 | 148% |
| Wc Society | $141 | 148% |
| Wc Srs | $141 | 148% |
| Wc Taconic (Mro) | $141 | 148% |
| Wc Taconic Farms | $141 | 148% |
| Wc Travelers | $141 | 148% |
| Wc Triad Group | $141 | 148% |
| Wc Tristar | $141 | 148% |
| Wc Troy Ny | $141 | 148% |
| Wc Tyson | $141 | 148% |
| Wc Unified Health Services | $141 | 148% |
| Wc United Heartland | $141 | 148% |
| Wc Us Dept Of Labor | $141 | 148% |
| Wc Walmart | $141 | 148% |
| Wc West Bend | $141 | 148% |
| Wc West Bend Mutual/Argent | $141 | 148% |
| Wc Winnebago Industries | $141 | 148% |
| Wc Yankee Trails | $141 | 148% |
| Wc York Risk | $141 | 148% |
| Wc Zenith | $141 | 148% |
| Wc Zurich | $141 | 148% |