CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Virginia Gay Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $148
Cash Discount Price: $157
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Virginia Gay Hospital is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.55x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$157

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

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: $157 (165%)

Insurance Median: $148 (155%)

Cash: $157 (165% of Medicare)

Ins. Median: $148 (155% 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
UnitedHealthcare	$35 - $156	37%
Va Ccn-All Plans	$38 - $121	40%
Medicaid / KanCare	$44 - $206	46%
Humana	$70 - $262	74%
Midlands Choice-All Plans	$78	82%
Cedar Valley Community Healthcare-All Plans	$81 - $258	85%
Wellmark Hmo	$85 - $174	89%
Health Partners-All Plans	$88 - $279	92%
Healthsmart-All Plans	$88 - $279	92%
Medical Associates-All Plans	$88 - $246	92%
Health Alliance-All Other Plans	$96 - $312	101%
Health Alliance Mcr Adv	$98 - $128	103%
Aetna	$155 - $318	163%
Wellmark Ppo-All Other Plans	$169 - $174	178%
Corvel-All Plans	$170 - $305	179%

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 $157.
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 Virginia Gay Hospital 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.