CMS Price Transparency Data
Hospital file updated: 2026-09-21
Office visit, established patient (20-29 min)
Facility: Shenandoah Medical Center
Billing Code: 99213 (CPT)
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
$85Fair BaseRate (1.38× Market)
Position vs. 1.00× Fair Price+38% Above Fair Price
1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.
This hospital's typical commercial price is $117 compared to the $85 fair price benchmark.
Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.High-Markup · Check Safety
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
The BaseRate · fair price medium confidence
A fair price for this
$85
about 0.9× the $95 Medicare rate · typically $56–$198
modeled estimate · not a bill or quote
Medicare pays $95 Fair price $85 Cash price $117 Hospital's list price $180
What each insurance company pays
Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.
3 of 6 major insurers have a published price at this hospital
UnitedHealthcareBlue Cross Blue ShieldAetna CignaHumanaKaiser 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 | $43 - $330 | 45% |
| Blue Cross Blue Shieldmajor | $93 | 98% |
| Aetnamajor | $46 - $205 | 48% |
| Amerigroup | $49 - $337 | 51% |
| Molina | $46 - $330 | 48% |
| WellCare | $46 - $75 | 48% |
| + 3 smaller / regional plans | $48 - $333 |
Government programs also on file: Military & VA.
Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.
Self-Pay How to get the cash price
Insurance Before you use insurance
Estimate your out-of-pocket cost
A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.
Enter your details and press estimate to compare.
Other Procedures at Shenandoah Medical Center
Compare: Office visit, established patient (20-29 min) at other IA hospitals
- Mercyone Newton Medical Center · Newton $31
- Sartori Memorial Hospital, Inc · Cedar Falls $31
- Mercyone Dubuque Medical Center · Dubuque $31
- Mercyone Oelwein Medical Center · Oelwein $31
- Dallas County Hospital · Perry $36
- Mercyone North Iowa Medical Center · Mason City $46
- Mercyone Waterloo Medical Center · Waterloo $46
- Mercy Medical Center-New Hampton · New Hampton $46
Insurance negotiated median for the same procedure, sorted lowest first.
Inline Bill X-Ray & 501(r) Calculator
501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%
Audit a Bill or Quote at Shenandoah Medical Center (Zero PHI Required)
CMS CCN: 161366
CPT 99213
Fair BaseRate™ $85
Medicare Rate $95
Self-Pay Cash $117
Insurer Median $98
Pre-filled with Shenandoah Medical Center’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check
501(r) AGB Cap: $65 (274% FPL)
Statutory 501(r) AGB Cap Limits Bill to $65
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $65).
Step 2 · Cash vs. Insurance Arbitrage
Save $63 Paying Cash
Self-Pay Cash Rate ($117) Beats Your Bill
Shenandoah Medical Center's published 45 CFR § 180 self-pay cash rate is $117 (vs. $98 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Step 3 · Fair BaseRate Target
+$95 Above Fair BaseRate
Negotiate Toward $85 Fair BaseRate ($95 Medicare)
Your bill ($180) is $95 above the denoised Fair BaseRate ($85) and 1.9× the $95 Medicare rate.
1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
45 CFR § 180 Primary-Source Lineage & Federal Verification
Verified
CMS CCN 161366
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Published MRF FileReports.aspx
Publication / Vintage2026-09-21 · 65.49 MB
Validated Rate Rows614,176 (CMS v3.0.0)
File Integrity Digestd3add3dd8a4465956332…
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.