CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Elkhart General Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $46
Cash Discount Price: $50
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Elkhart General Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.48x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $50 (53%)

Insurance Median: $46 (48%)

Cash: $50 (53% of Medicare)

Ins. Median: $46 (48% 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
Blue Cross Blue Shield	$11 - $57	12%
Devoted Healthcare	$11 - $46	12%
Aetna	$15 - $156	16%
Cha	$20 - $180	21%
Immergrun	$20 - $185	21%
Mhs	$22 - $300	23%
Php	$22 - $162	23%
Humana	$23 - $162	24%
UnitedHealthcare	$23 - $155	24%
Cigna	$24 - $176	25%
Multiplan	$24 - $166	25%
Encore	$25 - $171	26%
Signature	$25 - $169	26%
Plain Church	$27 - $185	28%
Heartland	$34 - $231	36%
Caresource	$44 - $300	46%
Mdwise	$44 - $300	46%

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 $50.
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 Elkhart General 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.