CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Cass County Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $58
Cash Discount Price: $92
vs. Medicare Baseline: 0.61x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Cass County Memorial Hospital is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $92. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.61x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$58

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: $92 (97%)

Insurance Median: $58 (61%)

Cash: $92 (97% of Medicare)

Ins. Median: $58 (61% 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
Midlands Choice Medica Mcr	$10 - $32	11%
Triwest - All Plans	$20 - $57	21%
Aetna	$21 - $132	22%
Amerigroup Mcr Adv - All Other Plans	$21 - $58	22%
Iowa Total Care Mcaid	$21 - $134	22%
Iowa Total Care Mcr	$21 - $60	22%
Molina Mcaid - All Plans	$21 - $134	22%
Tricare	$21 - $58	22%
UnitedHealthcare	$21 - $126	22%
Va Ccn - All Plans	$21 - $58	22%
Wellmark Mcr Adv	$21 - $59	22%
American Hlth Mcr Adv - All Plans	$22 - $60	23%
Medicaid / KanCare	$22 - $162	23%
Iowa Total Care Comm - All Other Plans	$23 - $64	24%
Midlands Choice New Bus	$32 - $97	34%
Midlands Choice Pho (Ppo) - All Other Plans	$45 - $125	47%
Multiplan - All Plans	$48 - $132	50%
Medica Mcr Adv	$58	61%
Wellmark Hmo	$93	98%
Wellmark Ppo - All Other Plans	$93	98%
Medica Comm - All Other Plans	$115 - $122	121%

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 $92.
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 Cass County Memorial 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.