CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sparrow Ionia Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $86
Cash Discount Price: $34
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Sparrow Ionia Hospital is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.90x the Medicare baseline. Located in 3565 S State Road, Ionia, MI.

Cash / Self-Pay

$34

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $34 (36%)

Insurance Median: $86 (90%)

Cash: $34 (36% of Medicare)

Ins. Median: $86 (90% 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	$31 - $103	33%
Covenant Advantage	$31 - $34	33%
Medicare (plans)	$31 - $86	33%
Medigold	$31 - $34	33%
Senior Community Care	$31 - $34	33%
Humana	$33 - $111	35%
Medicaid / KanCare	$42 - $59	44%
Priority	$76 - $84	80%
Blue Cross Blue Shield	$78 - $86	82%
UnitedHealthcare	$95 - $105	100%
Cigna	$98 - $108	103%
Great West Healthcare	$98 - $108	103%
Asr	$99 - $110	104%
Blue Care Network	$99 - $110	104%
Health Alliance Plan	$99 - $110	104%
Cofinity	$100 - $111	105%
Mclaren Commercial	$110 - $122	116%

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 $34.
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 Sparrow Ionia 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.