CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Saint Joseph Regional Medical Center - Plymouth

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $71
  • Cash Discount Price: $167
  • vs. Medicare Baseline: 0.75x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Saint Joseph Regional Medical Center - Plymouth is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.75x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$167

Average discount available for prompt cash payment at this facility.

Insurance Median
$71

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: $167 (175%)
Insurance Median: $71 (75%)
Cash: $167 (175% of Medicare)
Ins. Median: $71 (75% 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
Medicaid / KanCare $45 - $78 47%
Aetna $54 - $100 57%
Align Senior Care $54 - $75 57%
Ally Align Care Adv $54 - $75 57%
American Health Advantage Of Idaho $54 - $75 57%
American Health Plan $54 - $75 57%
Aurora Special Needs $54 - $75 57%
Blue Care Network Advantage $54 - $75 57%
Blue Cross Blue Shield $54 - $86 57%
Blue Shield - De (Highmark) Medciare Advantage $54 - $75 57%
Care Dimensions $54 - $75 57%
Care Improvement Plus $54 - $75 57%
Care Resources Pace $54 - $75 57%
Careplus Health Plans $54 - $75 57%
Cca - Zing Health $54 - $75 57%
Cca Senior Care Options $54 - $75 57%
Central Valley Medical Services Corp Pace $54 - $75 57%
Champion Health Plan Mcr Advantage $54 - $75 57%
Cigna $54 - $134 57%
Clear Spring Health $54 - $75 57%
Clover Health $54 - $75 57%
Commonwealth Care Alliance $54 - $75 57%
Community Pace At Home $54 - $75 57%
Eddy Senior Care-Pace $54 - $75 57%
Eddy Seniorcare Pace $54 - $75 57%
Elementcare $54 - $75 57%
Evercare $54 - $75 57%
Everence $54 - $75 57%
Gateway Health Plan $54 - $75 57%
Genesys Pace Of Genesee County $54 - $75 57%
Georgia Health Advantage $54 - $75 57%
Gold Advantage $54 - $75 57%
Gpa Croell Redi Mix $54 - $75 57%
Health America Advantra $54 - $75 57%
Highmark Health Options Dual Plan $54 - $75 57%
Hope Select Pace $54 - $75 57%
Horizon Nj Total Care $54 - $75 57%
Hudson Headwaters Pace $54 - $75 57%
Humana $54 - $75 57%
Huron Valley Pace $54 - $75 57%
Innovative Integrated Health Community Plans $54 - $75 57%
Iowa Health Advantage $54 - $75 57%
Johns Hopkins Advantage Md $54 - $75 57%
Lasso Healthcare Msa $54 - $75 57%
Life St Marys Pace $54 - $75 57%
Lifecircles Pace $54 - $75 57%
Longevity Health Plan $54 - $75 57%
Longevity Ipa Of Michigan Llc Health Plan Isnp $54 - $75 57%
Martins Point Generations Advantage $54 - $75 57%
Mass General Brigham Mcr Adv $54 - $75 57%
Medicare (plans) $54 - $78 57%
Medipak Advantage $54 - $75 57%
Mercy Life $54 - $75 57%
Mercyone Cedar Valley $54 - $75 57%
Meridian Complete $54 - $75 57%
Michigan Complete Health $54 - $75 57%
Nascentia Health Plus $54 - $75 57%
New Centry Health Careplus $54 - $75 57%
Osu Prime Care Advantage $54 - $75 57%
Pace Cny $54 - $75 57%
Pace Iowa Immanuel Pathways $54 - $75 57%
Pace Of Southwest Michigan $54 - $75 57%
Pace Southeast $54 - $75 57%
Pace-Trinity Health $54 - $75 57%
Peak Pace Solutions $54 - $75 57%
Perennial Advantage $54 - $75 57%
Preferred Care Partners $54 - $75 57%
Presbyterian Senior Plan $54 - $75 57%
Provider Partners Health Plan Of Illinois $54 - $75 57%
Pruitthealth Premier $54 - $75 57%
Reliance Community Care Partners Care Resources Pace $54 - $75 57%
Rx Allwin $54 - $75 57%
Rx Grane Grnmedd $54 - $75 57%
Rx Retiree Rx Care $54 - $75 57%
Scan Health Plan Mcr Ipa Meritage Oon $54 - $75 57%
Secure Horizons Ma Pffs $54 - $75 57%
Serenity Pace $54 - $75 57%
Siouxland Pace $54 - $75 57%
Solis Health Plans $54 - $75 57%
Sunnyview-Pace Finance Dept $54 - $75 57%
Texan Plus $54 - $75 57%
The Health Plan $54 - $75 57%
Thome Pace $54 - $75 57%
Todays Options $54 - $75 57%
Tribute Health Plans $54 - $75 57%
Um Health Advantage $54 - $75 57%
Union Health Service $54 - $75 57%
UnitedHealthcare $54 - $76 57%
Welbe Health $54 - $75 57%
Wellmed $54 - $75 57%
Andrie Inc $55 - $77 58%
East Greenbush Central School District $55 - $77 58%
Genex Wc $55 - $77 58%
Healthsmart Workers Comp $55 - $77 58%
Jag Source $55 - $77 58%
New York State Insurance Fund $55 - $77 58%
Njm Insurance Group $55 - $77 58%
Rx Heatlhcomp $55 - $77 58%
Rx Restat $55 - $77 58%
Rx Saif Opdp Wc $55 - $77 58%
Rx Worker'S Comp $55 - $77 58%
Veterans Administration $55 - $77 58%
Wc Accident Fund $55 - $77 58%
Wc Ace $55 - $77 58%
Wc Acs Federal Employees $55 - $77 58%
Wc Acuity $55 - $77 58%
Wc Advantage $55 - $77 58%
Wc Aegis $55 - $77 58%
Wc Aig $55 - $77 58%
Wc Aims $55 - $77 58%
Wc Alaska National Ins $55 - $77 58%
Wc Align Network $55 - $77 58%
Wc Allied $55 - $77 58%
Wc Am Trust N America $55 - $77 58%
Wc American Claims Mgmt $55 - $77 58%
Wc Amerisure $55 - $77 58%
Wc Amtrust $55 - $77 58%
Wc Asu Risk Mgt $55 - $77 58%
Wc Benetech $55 - $77 58%
Wc Berkley Admin $55 - $77 58%
Wc Broadspire $55 - $77 58%
Wc Broward County $55 - $77 58%
Wc Bunch & Associates $55 - $77 58%
Wc California State Comp Ins $55 - $77 58%
Wc California State Ins Fund $55 - $77 58%
Wc Capitol Area Health Consortium $55 - $77 58%
Wc Ccmsi $55 - $77 58%
Wc Chartis $55 - $77 58%
Wc Chubb $55 - $77 58%
Wc Cirma $55 - $77 58%
Wc City Of Albany $55 - $77 58%
Wc City Of Sioux City $55 - $77 58%
Wc Claims Mgmt Inc $55 - $77 58%
Wc Cna $55 - $77 58%
Wc Comp One Admin C/O Manageability $55 - $77 58%
Wc Compone Admin $55 - $77 58%
Wc Corvel $55 - $77 58%
Wc Ct Healthcare Trust $55 - $77 58%
Wc Donegal Insurance Group $55 - $77 58%
Wc Emc Insurance Company $55 - $77 58%
Wc Employee Mutual $55 - $77 58%
Wc Enablecomp $55 - $77 58%
Wc Erie $55 - $77 58%
Wc Esis $55 - $77 58%
Wc Evolutions $55 - $77 58%
Wc Fcci $55 - $77 58%
Wc Fed Ex $55 - $77 58%
Wc Federal Black Lung $55 - $77 58%
Wc Federated $55 - $77 58%
Wc Finley Occupational Health $55 - $77 58%
Wc First Agency/Occunet $55 - $77 58%
Wc Ford Motor $55 - $77 58%
Wc Fresno Unified Emp $55 - $77 58%
Wc Gallagher Bassett $55 - $77 58%
Wc General Motors $55 - $77 58%
Wc Generic $55 - $77 58%
Wc Genex Care For Ohio $55 - $77 58%
Wc Great West Casualty $55 - $77 58%
Wc Guarantee Insurance $55 - $77 58%
Wc Guard Insurance Company $55 - $77 58%
Wc Hab $55 - $77 58%
Wc Hartford $55 - $77 58%
Wc Hastings $55 - $77 58%
Wc Health Management $55 - $77 58%
Wc Heritage Summit $55 - $77 58%
Wc Hireright $55 - $77 58%
Wc Horizon $55 - $77 58%
Wc Icw Group $55 - $77 58%
Wc Idaho State Ins Fund $55 - $77 58%
Wc Intercare Insurance $55 - $77 58%
Wc Intermountain $55 - $77 58%
Wc Johns Eastern $55 - $77 58%
Wc Kemberton $55 - $77 58%
Wc Key Ins & Benefit Solutions $55 - $77 58%
Wc Liberty Mutual $55 - $77 58%
Wc Mac Risk Management $55 - $77 58%
Wc Massachusetts $55 - $77 58%
Wc Mdia $55 - $77 58%
Wc Meadowbrook Claim $55 - $77 58%
Wc Medical Administrators $55 - $77 58%
Wc Meijers $55 - $77 58%
Wc Memic $55 - $77 58%
Wc Mercy Workcare $55 - $77 58%
Wc Michigan $55 - $77 58%
Wc Michigan Millers Mutual $55 - $77 58%
Wc Mitchell Frankenmuth $55 - $77 58%
Wc Mra $55 - $77 58%
Wc Nationwide $55 - $77 58%
Wc Nca Comp $55 - $77 58%
Wc New York $55 - $77 58%
Wc New York Special Funds $55 - $77 58%
Wc North American Rishces $55 - $77 58%
Wc Northeast Health $55 - $77 58%
Wc Notre Dame $55 - $77 58%
Wc Novanet $55 - $77 58%
Wc O'Hara Corp $55 - $77 58%
Wc Occ Health Allen $55 - $77 58%
Wc Ohio Bureau $55 - $77 58%
Wc One Call Medical $55 - $77 58%
Wc Paradigm $55 - $77 58%
Wc Peerless $55 - $77 58%
Wc Pma $55 - $77 58%
Wc Praxis Health Network $55 - $77 58%
Wc Price Chopper $55 - $77 58%
Wc Procura Management $55 - $77 58%
Wc Qualcare $55 - $77 58%
Wc Quiktrip $55 - $77 58%
Wc Reny Company $55 - $77 58%
Wc Rev Claims $55 - $77 58%
Wc Risico $55 - $77 58%
Wc Rural Mutual $55 - $77 58%
Wc Saif Oregon $55 - $77 58%
Wc Secura $55 - $77 58%
Wc Sedgwick $55 - $77 58%
Wc Sentry $55 - $77 58%
Wc Sheakley Unicomp $55 - $77 58%
Wc Smile Lodge $55 - $77 58%
Wc Society $55 - $77 58%
Wc Srs $55 - $77 58%
Wc Taconic (Mro) $55 - $77 58%
Wc Taconic Farms $55 - $77 58%
Wc Travelers $55 - $77 58%
Wc Triad Group $55 - $77 58%
Wc Tristar $55 - $77 58%
Wc Troy Ny $55 - $77 58%
Wc Tyson $55 - $77 58%
Wc Unified Health Services $55 - $77 58%
Wc United Heartland $55 - $77 58%
Wc Us Dept Of Labor $55 - $77 58%
Wc Velocity $55 - $77 58%
Wc Walmart $55 - $77 58%
Wc West Bend $55 - $77 58%
Wc West Bend Mutual/Argent $55 - $77 58%
Wc Winnebago Industries $55 - $77 58%
Wc Yankee Trails $55 - $77 58%
Wc York Risk $55 - $77 58%
Wc Zenith $55 - $77 58%
Wc Zurich $55 - $77 58%
Albany County Correctional Facility $61 - $71 64%
Ambetter / Centene $61 - $71 64%
Amish Mennonite $61 - $71 64%
Ascension St. Vincent Public Safety Medical $61 - $71 64%
Bcccp-Michigan $61 - $71 64%
Bccp $61 - $71 64%
Bmc Healthnet $61 - $71 64%
Breast Grant-Connecticut $61 - $71 64%
Broward County Dept Of Health $61 - $71 64%
California Health And Wellness $61 - $71 64%
Cardinal Innovations Lme $61 - $71 64%
Care Connections Of Northern Iowa $61 - $71 64%
Care Oregon Ohp $61 - $71 64%
Cencal Health Plan $61 - $71 64%
Cenpatico $61 - $71 64%
Champva $61 - $71 64%
Chhuny $61 - $71 64%
Childrens Comm Health Plan $61 - $71 64%
Childrens Medical Services Title 19 $61 - $71 64%
City Of Philadelphia $61 - $71 64%
Cmh Allegan County $61 - $71 64%
Cmh Ausable Valley $61 - $71 64%
Cmh Barry County $61 - $71 64%
Cmh Bay-Arenac County $61 - $71 64%
Cmh Berrien County $61 - $71 64%
Cmh Cass County $61 - $71 64%
Cmh Central Mi County $61 - $71 64%
Cmh Clinton-Eaton-Ingham County $61 - $71 64%
Cmh Detroit Wayne Integrated Health Network $61 - $71 64%
Cmh Genesee County $61 - $71 64%
Cmh Ionia County $61 - $71 64%
Cmh Jackson County/Lifeways $61 - $71 64%
Cmh Kalamazoo $61 - $71 64%
Cmh Kent County $61 - $71 64%
Cmh Lenawee County $61 - $71 64%
Cmh Livingston County $61 - $71 64%
Cmh Macomb $61 - $71 64%
Cmh Misc $61 - $71 64%
Cmh Monroe County $61 - $71 64%
Cmh Montcalm County $61 - $71 64%
Cmh Muskegon County $61 - $71 64%
Cmh Newaygo County $61 - $71 64%
Cmh North Country $61 - $71 64%
Cmh Northern Lakes County $61 - $71 64%
Cmh Oakland County $61 - $71 64%
Cmh Ottawa County $61 - $71 64%
Cmh Van Buren County $61 - $71 64%
Cmh Washtenaw County $61 - $71 64%
Cmh Wayne County/Carelink $61 - $71 64%
Cmh Wayne Cty/Com Liv Svcs $61 - $71 64%
Cmh West Mi County $61 - $71 64%
Community Benefit Health $61 - $71 64%
Community Care Behavorial Health $61 - $71 64%
Community Care Partners $61 - $71 64%
Community Health Choice $61 - $71 64%
Connections Csp $61 - $71 64%
County Coroner $61 - $71 64%
County Funding Generic $61 - $71 64%
Covid19 Hrsa Uninsured Testing And Treatment Fund $61 - $71 64%
Dean Wi Badgercare $61 - $71 64%
Delaware County Department Of Health $61 - $71 64%
Delaware First Health $61 - $71 64%
Delta Dental Nj $61 - $71 64%
Dph Tb Program $61 - $71 64%
Dscc $61 - $71 64%
Eastpointe Lme $61 - $71 64%
Family Health Network $61 - $71 64%
Freedom First Healthcare $61 - $71 64%
Fresno County Ccs $61 - $71 64%
Ghc Scw Wi Badgercare $61 - $71 64%
Harbor Health $61 - $71 64%
Health Safety Net $61 - $71 64%
Healthy Blue Ne $61 - $71 64%
Hennepin Health $61 - $71 64%
Id County Ada $61 - $71 64%
Id County Canyon $61 - $71 64%
Id County Cat Fund $61 - $71 64%
Id County Other $61 - $71 64%
Id County Payette $61 - $71 64%
Idaho Dept Health And Wellfare $61 - $71 64%
Idaho Womens Health Check $61 - $71 64%
Indiana Breast Cervical Cancer $61 - $71 64%
Inland Empire Health Plan $61 - $71 64%
Intercommunity Health Ohp $61 - $71 64%
Iowa Total Care $61 - $71 64%
Jai Medical System $61 - $71 64%
Kern Family Health Plan $61 - $71 64%
Keystone First $61 - $71 64%
Keystone First Chip $61 - $71 64%
La Care Health Plan $61 - $71 64%
Lakeland Care Inc $61 - $71 64%
Managed Health Services - Indiana $61 - $71 64%
Maryland Breast & Cervical Program $61 - $71 64%
Maryland Healthy Smiles - Scion Dental $61 - $71 64%
Maryland Physicians Care $61 - $71 64%
Massachusetts Behavioral Health Partnership $61 - $71 64%
Mdwise $61 - $71 64%
Medi-Cal $61 - $71 64%
Medi-Cal Healthnet $61 - $71 64%
Medstar Dc Healthy Family $61 - $71 64%
Medstar Md Health Choice $61 - $71 64%
Mo Home State Health Plan $61 - $71 64%
Molina Centennial Care $61 - $71 64%
Nascentia Health Options $61 - $71 64%
Nebraska Total Care $61 - $71 64%
New York Cancer Services Program $61 - $71 64%
Nextlevel Health $61 - $71 64%
Oregon Screenwise $61 - $71 64%
Paramount Advantage $61 - $71 64%
Parkland Community Health Plan $61 - $71 64%
Partners Behavioral Lme $61 - $71 64%
Peach State Healthplan $61 - $71 64%
Philadelphia County Funding $61 - $71 64%
Presbyterian Centennial Care $61 - $71 64%
Prestige Health Choice $61 - $71 64%
Priority Partners $61 - $71 64%
Provider Partners Health Plan Of Indiana $61 - $84 64%
Robert F Sing Program $61 - $71 64%
Rx 340B Pass Along $61 - $71 64%
Rx Assistance/Rx Manufacturer Assistance 0 Copay $61 - $71 64%
Rx Medi-Cal $61 - $71 64%
Rx Meridian Rx $61 - $71 64%
Ryan White Florida Mssrp $61 - $71 64%
Sandhills Center Lme $61 - $71 64%
Screening For Life $61 - $71 64%
St Joseph County Hlth Dpt $61 - $71 64%
Stephenson Cty Health $61 - $71 64%
Sunshine State Health Plan $61 - $71 64%
Superior Health $61 - $71 64%
Tenncare $61 - $71 64%
Texas Children'S Health Plan $61 - $71 64%
Tricare $61 - $71 64%
Trillium Community Ohp $61 - $71 64%
Triwest Health Alliance $61 - $71 64%
Tufts Health Public Plans $61 - $71 64%
Us Family Health Plan $61 - $71 64%
Vaya Health Lme $61 - $71 64%
Veterans Eval Services $61 - $71 64%
Washtenaw Health Plan $61 - $71 64%
Wellsense Health Plan $61 - $71 64%
Wi Womens Wellness $61 - $71 64%
Caresource $72 - $100 76%
Christian Brother Services $72 - $100 76%
Meritain $72 - $100 76%
Preferred One $72 - $100 76%
Geha $76 80%
Community Health Alliance $82 - $95 86%
Ameriben $83 - $116 87%
Bcn Domestic $84 - $86 88%
Blue Benefit Administrators Of Massachusetts $84 - $86 88%
Blue Care Network $84 - $86 88%
Blue Distinction Transplant $84 - $86 88%
Blue Shield - Ca $84 - $86 88%
Blue Shield - Id (Regence) $84 - $86 88%
Blue Shield - Ny Highmark Northeastern $84 - $86 88%
Blue Shield - Ny Highmark Western $84 - $86 88%
Blue Shield - Pa (Highmark) $84 - $86 88%
Blue Shield - Wa (Regence) $84 - $86 88%
Health Choices $84 - $86 88%
Kaiser Domestic $84 - $86 88%
Pre-Employment $84 - $86 88%
Wc Domestic $84 - $86 88%
Allied Benefit Systems $91 - $126 96%
Auxiant $91 - $134 96%
Benefit Administrative Systems,Llc $91 - $126 96%
Custom Design Benefits $91 - $126 96%
Encore Health $91 - $134 96%
Key Benefit Administrator $91 - $126 96%
Luminare Health (Detroit) $91 - $126 96%
Physicians Health Plan Northern Indiana Health Insurance $91 - $126 96%
Sagamore Health Network $97 - $134 102%
Signature Care $97 - $134 102%
Wc Encore Health Network $118 124%
Phcs $126 - $175 132%
Plain Church Group $140 - $194 147%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1915 Lake Ave, Plymouth, IN 46563
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals