CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Highlands Arh Regional Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $56
Cash Discount Price: $92
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Highlands Arh Regional Medical Center is $56. 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 0.59x the Medicare baseline. Located in 5000 Kentucky Route 321, Prestonsburg, KY.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $56 (59%)

Cash: $92 (97% of Medicare)

Ins. Median: $56 (59% 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
Aetna	$21 - $594	22%
Blue Cross Blue Shield	$21 - $568	22%
Humana	$22 - $256	23%
Passport Molina	$22 - $254	23%
UnitedHealthcare	$33 - $381	35%
Caresoure Kentucky	$44 - $514	46%
Wellcare Of Kentucky	$56	59%

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 Highlands Arh Regional Medical Center 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.