CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Saint Joseph Regional Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $84
  • Cash Discount Price: $194
  • vs. Medicare Baseline: 0.88x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Saint Joseph Regional Medical Center is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $194. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.88x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$194

Average discount available for prompt cash payment at this facility.

Insurance Median
$84

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: $194 (204%)
Insurance Median: $84 (88%)
Cash: $194 (204% of Medicare)
Ins. Median: $84 (88% 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.

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
Aetna $10 - $118 11%
Albany County Correctional Facility $10 - $84 11%
Ambetter / Centene $10 - $84 11%
Amish Mennonite $10 - $84 11%
Ascension St. Vincent Public Safety Medical $10 - $84 11%
Bcccp-Michigan $10 - $84 11%
Bccp $10 - $84 11%
Blue Cross Blue Shield $10 - $834 11%
Bmc Healthnet $10 - $84 11%
Breast Grant-Connecticut $10 - $84 11%
Broward County Dept Of Health $10 - $84 11%
California Health And Wellness $10 - $84 11%
Cardinal Innovations Lme $10 - $84 11%
Care Connections Of Northern Iowa $10 - $84 11%
Care Oregon Ohp $10 - $84 11%
Cencal Health Plan $10 - $84 11%
Cenpatico $10 - $84 11%
Champva $10 - $84 11%
Chhuny $10 - $84 11%
Childrens Comm Health Plan $10 - $84 11%
Childrens Medical Services Title 19 $10 - $84 11%
Cigna $10 - $134 11%
City Of Philadelphia $10 - $84 11%
Cmh Allegan County $10 - $84 11%
Cmh Ausable Valley $10 - $84 11%
Cmh Barry County $10 - $84 11%
Cmh Bay-Arenac County $10 - $84 11%
Cmh Berrien County $10 - $84 11%
Cmh Cass County $10 - $84 11%
Cmh Central Mi County $10 - $84 11%
Cmh Clinton-Eaton-Ingham County $10 - $84 11%
Cmh Detroit Wayne Integrated Health Network $10 - $84 11%
Cmh Genesee County $10 - $84 11%
Cmh Ionia County $10 - $84 11%
Cmh Jackson County/Lifeways $10 - $84 11%
Cmh Kalamazoo $10 - $84 11%
Cmh Kent County $10 - $84 11%
Cmh Lenawee County $10 - $84 11%
Cmh Livingston County $10 - $84 11%
Cmh Macomb $10 - $84 11%
Cmh Misc $10 - $84 11%
Cmh Monroe County $10 - $84 11%
Cmh Montcalm County $10 - $84 11%
Cmh Muskegon County $10 - $84 11%
Cmh Newaygo County $10 - $84 11%
Cmh North Country $10 - $84 11%
Cmh Northern Lakes County $10 - $84 11%
Cmh Oakland County $10 - $84 11%
Cmh Ottawa County $10 - $84 11%
Cmh Van Buren County $10 - $84 11%
Cmh Washtenaw County $10 - $84 11%
Cmh Wayne County/Carelink $10 - $84 11%
Cmh Wayne Cty/Com Liv Svcs $10 - $84 11%
Cmh West Mi County $10 - $84 11%
Community Benefit Health $10 - $84 11%
Community Care Behavorial Health $10 - $84 11%
Community Care Partners $10 - $84 11%
Community Health Choice $10 - $84 11%
Connections Csp $10 - $84 11%
County Coroner $10 - $84 11%
County Funding Generic $10 - $84 11%
Covid19 Hrsa Uninsured Testing And Treatment Fund $10 - $84 11%
Dean Wi Badgercare $10 - $84 11%
Delaware County Department Of Health $10 - $84 11%
Delaware First Health $10 - $84 11%
Delta Dental Nj $10 - $84 11%
Dph Tb Program $10 - $84 11%
Dscc $10 - $84 11%
Eastpointe Lme $10 - $84 11%
Family Health Network $10 - $84 11%
Freedom First Healthcare $10 - $84 11%
Fresno County Ccs $10 - $84 11%
Ghc Scw Wi Badgercare $10 - $84 11%
Harbor Health $10 - $84 11%
Health Safety Net $10 - $84 11%
Healthy Blue Ne $10 - $84 11%
Hennepin Health $10 - $84 11%
Humana $10 - $88 11%
Id County Ada $10 - $84 11%
Id County Canyon $10 - $84 11%
Id County Cat Fund $10 - $84 11%
Id County Other $10 - $84 11%
Id County Payette $10 - $84 11%
Idaho Dept Health And Wellfare $10 - $84 11%
Idaho Womens Health Check $10 - $84 11%
Indiana Breast Cervical Cancer $10 - $84 11%
Inland Empire Health Plan $10 - $84 11%
Intercommunity Health Ohp $10 - $84 11%
Iowa Total Care $10 - $84 11%
Jai Medical System $10 - $84 11%
Kern Family Health Plan $10 - $84 11%
Keystone First $10 - $84 11%
Keystone First Chip $10 - $84 11%
La Care Health Plan $10 - $84 11%
Lakeland Care Inc $10 - $84 11%
Managed Health Services - Indiana $10 - $159 11%
Maryland Breast & Cervical Program $10 - $84 11%
Maryland Healthy Smiles - Scion Dental $10 - $84 11%
Maryland Physicians Care $10 - $84 11%
Massachusetts Behavioral Health Partnership $10 - $84 11%
Mdwise $10 - $159 11%
Medi-Cal $10 - $84 11%
Medi-Cal Healthnet $10 - $84 11%
Medicaid / KanCare $10 - $159 11%
Medstar Dc Healthy Family $10 - $84 11%
Medstar Md Health Choice $10 - $84 11%
Mo Home State Health Plan $10 - $84 11%
Molina Centennial Care $10 - $84 11%
Nascentia Health Options $10 - $84 11%
Nebraska Total Care $10 - $84 11%
New York Cancer Services Program $10 - $84 11%
Nextlevel Health $10 - $84 11%
Oregon Screenwise $10 - $84 11%
Pace Of Southwest Michigan $10 - $88 11%
Paramount Advantage $10 - $84 11%
Parkland Community Health Plan $10 - $84 11%
Partners Behavioral Lme $10 - $84 11%
Peach State Healthplan $10 - $84 11%
Philadelphia County Funding $10 - $84 11%
Presbyterian Centennial Care $10 - $84 11%
Prestige Health Choice $10 - $84 11%
Priority Partners $10 - $84 11%
Provider Partners Health Plan Of Indiana $10 - $99 11%
Robert F Sing Program $10 - $84 11%
Rx 340B Pass Along $10 - $84 11%
Rx Assistance/Rx Manufacturer Assistance 0 Copay $10 - $84 11%
Rx Medi-Cal $10 - $84 11%
Rx Meridian Rx $10 - $84 11%
Ryan White Florida Mssrp $10 - $84 11%
Sandhills Center Lme $10 - $84 11%
Screening For Life $10 - $84 11%
St Joseph County Hlth Dpt $10 - $84 11%
Stephenson Cty Health $10 - $84 11%
Sunshine State Health Plan $10 - $84 11%
Superior Health $10 - $84 11%
Tenncare $10 - $84 11%
Texas Children'S Health Plan $10 - $84 11%
Tricare $10 - $84 11%
Trillium Community Ohp $10 - $84 11%
Triwest Health Alliance $10 - $84 11%
Tufts Health Public Plans $10 - $84 11%
UnitedHealthcare $10 - $159 11%
Us Family Health Plan $10 - $84 11%
Vaya Health Lme $10 - $84 11%
Veterans Eval Services $10 - $84 11%
Washtenaw Health Plan $10 - $84 11%
Wellsense Health Plan $10 - $84 11%
Wi Womens Wellness $10 - $84 11%
Andrie Inc $11 - $90 12%
Caresource $11 - $646 12%
East Greenbush Central School District $11 - $90 12%
Genex Wc $11 - $90 12%
Healthsmart Workers Comp $11 - $90 12%
Jag Source $11 - $90 12%
New York State Insurance Fund $11 - $90 12%
Njm Insurance Group $11 - $90 12%
Rx Heatlhcomp $11 - $90 12%
Rx Restat $11 - $90 12%
Rx Saif Opdp Wc $11 - $90 12%
Rx Worker'S Comp $11 - $90 12%
Wc Accident Fund $11 - $90 12%
Wc Ace $11 - $90 12%
Wc Acs Federal Employees $11 - $90 12%
Wc Acuity $11 - $90 12%
Wc Advantage $11 - $90 12%
Wc Aegis $11 - $90 12%
Wc Aig $11 - $90 12%
Wc Aims $11 - $90 12%
Wc Alaska National Ins $11 - $90 12%
Wc Align Network $11 - $90 12%
Wc Allied $11 - $90 12%
Wc Am Trust N America $11 - $90 12%
Wc American Claims Mgmt $11 - $90 12%
Wc Amerisure $11 - $90 12%
Wc Amtrust $11 - $90 12%
Wc Asu Risk Mgt $11 - $90 12%
Wc Benetech $11 - $90 12%
Wc Berkley Admin $11 - $90 12%
Wc Broadspire $11 - $90 12%
Wc Broward County $11 - $90 12%
Wc Bunch & Associates $11 - $90 12%
Wc California State Comp Ins $11 - $90 12%
Wc California State Ins Fund $11 - $90 12%
Wc Capitol Area Health Consortium $11 - $90 12%
Wc Ccmsi $11 - $90 12%
Wc Chartis $11 - $90 12%
Wc Chubb $11 - $90 12%
Wc Cirma $11 - $90 12%
Wc City Of Albany $11 - $90 12%
Wc City Of Sioux City $11 - $90 12%
Wc Claims Mgmt Inc $11 - $90 12%
Wc Cna $11 - $90 12%
Wc Comp One Admin C/O Manageability $11 - $90 12%
Wc Compone Admin $11 - $90 12%
Wc Corvel $11 - $90 12%
Wc Ct Healthcare Trust $11 - $90 12%
Wc Donegal Insurance Group $11 - $90 12%
Wc Emc Insurance Company $11 - $90 12%
Wc Employee Mutual $11 - $90 12%
Wc Enablecomp $11 - $90 12%
Wc Erie $11 - $90 12%
Wc Esis $11 - $90 12%
Wc Evolutions $11 - $90 12%
Wc Fcci $11 - $90 12%
Wc Fed Ex $11 - $90 12%
Wc Federal Black Lung $11 - $90 12%
Wc Federated $11 - $90 12%
Wc Finley Occupational Health $11 - $90 12%
Wc First Agency/Occunet $11 - $90 12%
Wc Ford Motor $11 - $90 12%
Wc Fresno Unified Emp $11 - $90 12%
Wc Gallagher Bassett $11 - $90 12%
Wc General Motors $11 - $90 12%
Wc Generic $11 - $90 12%
Wc Genex Care For Ohio $11 - $90 12%
Wc Great West Casualty $11 - $90 12%
Wc Guarantee Insurance $11 - $90 12%
Wc Guard Insurance Company $11 - $90 12%
Wc Hab $11 - $90 12%
Wc Hartford $11 - $90 12%
Wc Hastings $11 - $90 12%
Wc Health Management $11 - $90 12%
Wc Heritage Summit $11 - $90 12%
Wc Hireright $11 - $90 12%
Wc Horizon $11 - $90 12%
Wc Icw Group $11 - $90 12%
Wc Idaho State Ins Fund $11 - $90 12%
Wc Intercare Insurance $11 - $90 12%
Wc Intermountain $11 - $90 12%
Wc Johns Eastern $11 - $90 12%
Wc Kemberton $11 - $90 12%
Wc Key Ins & Benefit Solutions $11 - $90 12%
Wc Liberty Mutual $11 - $90 12%
Wc Mac Risk Management $11 - $90 12%
Wc Massachusetts $11 - $90 12%
Wc Mdia $11 - $90 12%
Wc Meadowbrook Claim $11 - $90 12%
Wc Medical Administrators $11 - $90 12%
Wc Meijers $11 - $90 12%
Wc Memic $11 - $90 12%
Wc Mercy Workcare $11 - $90 12%
Wc Michigan $11 - $90 12%
Wc Michigan Millers Mutual $11 - $90 12%
Wc Mitchell Frankenmuth $11 - $90 12%
Wc Mra $11 - $90 12%
Wc Nationwide $11 - $90 12%
Wc Nca Comp $11 - $90 12%
Wc New York $11 - $90 12%
Wc New York Special Funds $11 - $90 12%
Wc North American Rishces $11 - $90 12%
Wc Northeast Health $11 - $90 12%
Wc Notre Dame $11 - $90 12%
Wc Novanet $11 - $90 12%
Wc O'Hara Corp $11 - $90 12%
Wc Occ Health Allen $11 - $90 12%
Wc Ohio Bureau $11 - $90 12%
Wc One Call Medical $11 - $90 12%
Wc Paradigm $11 - $90 12%
Wc Peerless $11 - $90 12%
Wc Pma $11 - $90 12%
Wc Praxis Health Network $11 - $90 12%
Wc Price Chopper $11 - $90 12%
Wc Procura Management $11 - $90 12%
Wc Qualcare $11 - $90 12%
Wc Quiktrip $11 - $90 12%
Wc Reny Company $11 - $90 12%
Wc Rev Claims $11 - $90 12%
Wc Risico $11 - $90 12%
Wc Rural Mutual $11 - $90 12%
Wc Saif Oregon $11 - $90 12%
Wc Secura $11 - $90 12%
Wc Sedgwick $11 - $90 12%
Wc Sentry $11 - $90 12%
Wc Sheakley Unicomp $11 - $90 12%
Wc Smile Lodge $11 - $90 12%
Wc Society $11 - $90 12%
Wc Srs $11 - $90 12%
Wc Taconic (Mro) $11 - $90 12%
Wc Taconic Farms $11 - $90 12%
Wc Travelers $11 - $90 12%
Wc Triad Group $11 - $90 12%
Wc Tristar $11 - $90 12%
Wc Troy Ny $11 - $90 12%
Wc Tyson $11 - $90 12%
Wc Unified Health Services $11 - $90 12%
Wc United Heartland $11 - $90 12%
Wc Us Dept Of Labor $11 - $90 12%
Wc Velocity $11 - $90 12%
Wc Walmart $11 - $90 12%
Wc West Bend $11 - $90 12%
Wc West Bend Mutual/Argent $11 - $90 12%
Wc Winnebago Industries $11 - $90 12%
Wc Yankee Trails $11 - $90 12%
Wc York Risk $11 - $90 12%
Wc Zenith $11 - $90 12%
Wc Zurich $11 - $90 12%
Christian Brother Services $12 - $118 13%
Geha $12 - $109 13%
Meritain $12 - $118 13%
Preferred One $12 - $118 13%
Ameriben $13 - $121 14%
Bcn Domestic $13 - $101 14%
Blue Benefit Administrators Of Massachusetts $13 - $834 14%
Blue Care Network $13 - $834 14%
Blue Distinction Transplant $13 - $834 14%
Blue Shield - Ca $13 - $834 14%
Blue Shield - Id (Regence) $13 - $834 14%
Blue Shield - Ny Highmark Northeastern $13 - $834 14%
Blue Shield - Ny Highmark Western $13 - $834 14%
Blue Shield - Pa (Highmark) $13 - $834 14%
Blue Shield - Wa (Regence) $13 - $834 14%
Community Health Alliance $13 - $95 14%
Health Choices $13 - $101 14%
Kaiser Domestic $13 - $101 14%
Pre-Employment $13 - $101 14%
Wc Domestic $13 - $101 14%
Align Senior Care $14 - $88 15%
Ally Align Care Adv $14 - $88 15%
American Health Advantage Of Idaho $14 - $88 15%
American Health Plan $14 - $88 15%
Aurora Special Needs $14 - $88 15%
Blue Care Network Advantage $14 - $88 15%
Blue Shield - De (Highmark) Medciare Advantage $14 - $88 15%
Care Dimensions $14 - $88 15%
Care Improvement Plus $14 - $88 15%
Care Resources Pace $14 - $88 15%
Careplus Health Plans $14 - $88 15%
Cca - Zing Health $14 - $88 15%
Cca Senior Care Options $14 - $88 15%
Central Valley Medical Services Corp Pace $14 - $88 15%
Champion Health Plan Mcr Advantage $14 - $88 15%
Clear Spring Health $14 - $88 15%
Clover Health $14 - $88 15%
Commonwealth Care Alliance $14 - $88 15%
Community Pace At Home $14 - $88 15%
Eddy Senior Care-Pace $14 - $88 15%
Eddy Seniorcare Pace $14 - $88 15%
Elementcare $14 - $88 15%
Evercare $14 - $88 15%
Everence $14 - $88 15%
Gateway Health Plan $14 - $88 15%
Genesys Pace Of Genesee County $14 - $88 15%
Georgia Health Advantage $14 - $88 15%
Gold Advantage $14 - $88 15%
Gpa Croell Redi Mix $14 - $88 15%
Health America Advantra $14 - $88 15%
Highmark Health Options Dual Plan $14 - $88 15%
Hope Select Pace $14 - $88 15%
Horizon Nj Total Care $14 - $88 15%
Hudson Headwaters Pace $14 - $88 15%
Huron Valley Pace $14 - $88 15%
Innovative Integrated Health Community Plans $14 - $88 15%
Iowa Health Advantage $14 - $88 15%
Johns Hopkins Advantage Md $14 - $88 15%
Lasso Healthcare Msa $14 - $88 15%
Life St Marys Pace $14 - $88 15%
Lifecircles Pace $14 - $88 15%
Longevity Health Plan $14 - $88 15%
Longevity Ipa Of Michigan Llc Health Plan Isnp $14 - $88 15%
Martins Point Generations Advantage $14 - $88 15%
Mass General Brigham Mcr Adv $14 - $88 15%
Medicare (plans) $14 - $92 15%
Medipak Advantage $14 - $88 15%
Mercy Life $14 - $88 15%
Mercyone Cedar Valley $14 - $88 15%
Meridian Complete $14 - $88 15%
Michigan Complete Health $14 - $88 15%
Nascentia Health Plus $14 - $88 15%
New Centry Health Careplus $14 - $88 15%
Osu Prime Care Advantage $14 - $88 15%
Pace Cny $14 - $88 15%
Pace Iowa Immanuel Pathways $14 - $88 15%
Pace Southeast $14 - $88 15%
Pace-Trinity Health $14 - $88 15%
Peak Pace Solutions $14 - $88 15%
Perennial Advantage $14 - $88 15%
Preferred Care Partners $14 - $88 15%
Presbyterian Senior Plan $14 - $88 15%
Provider Partners Health Plan Of Illinois $14 - $88 15%
Pruitthealth Premier $14 - $88 15%
Reliance Community Care Partners Care Resources Pace $14 - $88 15%
Rx Allwin $14 - $88 15%
Rx Grane Grnmedd $14 - $88 15%
Rx Retiree Rx Care $14 - $88 15%
Scan Health Plan Mcr Ipa Meritage Oon $14 - $88 15%
Secure Horizons Ma Pffs $14 - $88 15%
Serenity Pace $14 - $88 15%
Siouxland Pace $14 - $88 15%
Solis Health Plans $14 - $88 15%
Sunnyview-Pace Finance Dept $14 - $88 15%
Texan Plus $14 - $88 15%
The Health Plan $14 - $88 15%
Thome Pace $14 - $88 15%
Todays Options $14 - $88 15%
Tribute Health Plans $14 - $88 15%
Um Health Advantage $14 - $88 15%
Union Health Service $14 - $88 15%
Veterans Administration $14 - $90 15%
Welbe Health $14 - $88 15%
Wellmed $14 - $88 15%
Allied Benefit Systems $15 - $126 16%
Auxiant $15 - $134 16%
Benefit Administrative Systems,Llc $15 - $126 16%
Custom Design Benefits $15 - $126 16%
Encore Health $15 - $134 16%
Key Benefit Administrator $15 - $126 16%
Luminare Health (Detroit) $15 - $126 16%
Physicians Health Plan Northern Indiana Health Insurance $15 - $166 16%
Sagamore Health Network $16 - $134 17%
Signature Care $16 - $134 17%
Wc Encore Health Network $19 - $118 20%
Phcs $20 - $181 21%
Plain Church Group $22 - $201 23%
Siho Insurance Services $88 92%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals