CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mercyone Waterloo Medical Center

Billing Code: 99213 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$69

about 0.7× the $95 Medicare rate · typically $45–$79

modeled estimate · not a bill or quote

What this hospital charges insurers

$46

Below the fair price — a good deal

about $23 under the fair price · 0.5× Medicare

Medicare pays $95 Fair price $69 This hospital $46 Hospital's list price $141

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

A typical price — 0 charge more and 5 charge less, among the 9 IA hospitals compared.

Cheapest $31 Priciest $46

Black dot = this hospital, among the 9 IA hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $69 (about 0.7× the $95 Medicare rate). Mercyone Waterloo Medical Center charges insurers about $46 — below the fair price — a good deal. Located in Waterloo, IA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$26 - $93	27%
Blue Cross Blue Shieldmajor	$26 - $207	27%
Aetnamajor	$45 - $141	47%
Cignamajor	$26 - $112	27%
Humanamajor	$26 - $74	27%
Kaiser Permanentemajor	$79 - $207	83%
Ambetter (Centene)	$26 - $327	27%
Clover Health	$46	48%
GEHA	$67 - $93	70%
Health Net	$26 - $141	27%
HealthPartners	$26 - $104	27%
Meridian	$26 - $46	27%
Molina	$26	27%
Oscar Health	$84 - $86	88%
Paramount	$26	27%
Presbyterian	$26 - $46	27%
Sanford Health Plan	$78	82%
Tufts Health Plan	$26	27%
UCare	$83	87%
WellMed	$46	48%
WellSense	$26	27%
+ 356 smaller / regional plans	$26 - $207

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 15 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm Mercyone Waterloo Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercyone Waterloo Medical Center

Compare: Office visit, established patient (20-29 min) at other IA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.