CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: McLaren Macomb

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $67
Cash Discount Price: $95
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at McLaren Macomb is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.70x the Medicare baseline. Located in 1000 Harrington St, Mount Clemens, MI.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $95 (100%)

Insurance Median: $67 (70%)

Cash: $95 (100% of Medicare)

Ins. Median: $67 (70% 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
Medicaid / KanCare	$42 - $44	44%
Mclaren Commercial Ins	$43 - $58	45%
Humana	$57	60%
Medicare (plans)	$57 - $59	60%
UnitedHealthcare	$57 - $306	60%
Workers Compensation	$58 - $66	61%
Hap - Hmo	$64	67%
U Of M Health Plan	$65	68%
Aetna	$68 - $280	71%
Priority Health	$73 - $254	77%
Blue Cross Blue Shield	$86	90%
Cofinity Group 15892 & 15893	$93 - $106	98%

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 $95.
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 McLaren Macomb 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.