CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Charlevoix Area Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $98
Cash Discount Price: $121
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Charlevoix Area Hospital is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.03x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $121 (127%)

Insurance Median: $98 (103%)

Cash: $121 (127% of Medicare)

Ins. Median: $98 (103% 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	$28 - $147	29%
Blue Care Network	$28 - $77	29%
Hap (Health Alliance Plan)	$28 - $137	29%
Mclaren Health Plan	$28 - $152	29%
Medicare (plans)	$28 - $77	29%
Michigan Amish Medical Board	$28 - $77	29%
Northern Michigan Mennonite Group	$28 - $77	29%
Priority Health	$28 - $163	29%
UnitedHealthcare	$28 - $142	29%
Molina	$30 - $83	32%
Hospice Of Michigan	$35 - $98	37%
Meridian	$42 - $64	44%
Blue Cross Blue Shield	$43 - $151	45%
Asr Physicians Care Network	$47 - $130	49%
Employee Benefits Logistics	$47 - $130	49%
Enterprise Group Planning Employee Benefit Plan	$47 - $130	49%
First Health/Coventry Health/Community Care Network	$47 - $130	49%
Medical Cost Savings Solution	$47 - $130	49%
Provider Network Of America/Hma Group Health	$50 - $139	53%
Three Rivers Provider Network	$50 - $139	53%
Iba Health And Life Assurance Company	$54 - $150	57%
Cofinity	$55 - $152	58%
Nomi Health	$55 - $152	58%
Preferred Medical Claim Solutions	$56 - $155	59%
Cigna	$59 - $163	62%

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 $121.
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 Charlevoix Area 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.