CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Pine Rest Christian Mental Health Services

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $74
Cash Discount Price: $113
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Pine Rest Christian Mental Health Services is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.78x the Medicare baseline. Located in 300 - 68Th Street, Se, Grand Rapids, MI.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$74

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: $113 (119%)

Insurance Median: $74 (78%)

Cash: $113 (119% of Medicare)

Ins. Median: $74 (78% 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	$34 - $58	36%
Golden Rule [1131]	$36 - $92	38%
Healthscope Benefits [1140]	$36 - $92	38%
Ubh [1167]	$36 - $92	38%
UnitedHealthcare	$36 - $92	38%
Aetna	$42 - $135	44%
Blue Cross Blue Shield	$42 - $89	44%
Champva [1117]	$55 - $88	58%
Humana	$55 - $98	58%
Medicare (plans)	$55 - $88	58%
Molina [1156]	$55 - $88	58%
Tricare	$55 - $88	58%
Veterans Administration [1174]	$55 - $88	58%
Blue Care Network [1000]	$73 - $86	77%
Mclaren Health Plan [1149]	$73	77%
Asr Physicians Care Health Plan [1160]	$76 - $89	80%
Hap Ppo/Health Alliance Plan [1134]	$76 - $89	80%
Behavioral Health Systems [1115]	$77 - $91	81%
University Of Michigan Health Plan Comm [1159]	$81 - $95	85%
University Of Michigan Health Plan [1205]	$81 - $95	85%
Beacon/Carelon Behavioral Health [1198]	$82 - $100	86%
Manistee Benzie County Cmh [3526]	$86	90%
Ambetter / Centene	$90	95%
Network 180 [3530]	$91	96%
Priority Health [1300]	$96	101%
Cigna	$101	106%
Compsych [1122]	$114 - $162	120%
Cofinity [1120]	$115 - $135	121%
Geha [1129]	$115 - $135	121%
Meritain Health Plan [1153]	$115 - $135	121%

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 $113.
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 Pine Rest Christian Mental Health Services 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.