CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Hendricks Regional Health

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $98
Cash Discount Price: $45
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Hendricks Regional Health is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.03x the Medicare baseline. Located in 1000 E Main St, Danville, IN.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $45 (47%)

Insurance Median: $98 (103%)

Cash: $45 (47% of Medicare)

Ins. Median: $98 (103% 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
Sagamore Health Incumbent Program	$43 - $98	45%
Sagamorehealth Network	$43 - $104	45%
UnitedHealthcare	$57 - $96	60%
Aetna	$61 - $127	64%
Blue Cross Blue Shield	$61 - $141	64%
Humana	$61 - $112	64%
Siho Commercial Network	$72 - $108	76%
Cigna	$86 - $100	90%
Encore Health Network	$86 - $123	90%
Medicare (plans)	$86	90%
Encore Encircle Network	$94	99%
Caresource Exchange	$113	119%
Ambetter / Centene	$117	123%
Multiplan	$119 - $122	125%
Multiplan/ Complementary	$122 - $130	128%
Multiplan/Beech Street	$122 - $128	128%

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 $45.
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 Hendricks Regional Health 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.