CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Cox Medical Centers

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $80
Cash Discount Price: $42
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Cox Medical Centers is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.84x the Medicare baseline. Located in 3801 South National Avenue, Springfield, MO.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $42 (44%)

Insurance Median: $80 (84%)

Cash: $42 (44% of Medicare)

Ins. Median: $80 (84% 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
Cox Healthplans	$56	59%
Health Net Federal Services	$56	59%
Humana	$56	59%
Medrisk Llc	$56	59%
UnitedHealthcare	$56	59%
Blue Cross Blue Shield	$57	60%
Allwell	$58	61%
Devoted	$60	63%
Provider Partners Health Plan	$60	63%
Parkcrest Dental Group	$76	80%
Coastal Energy Corporation	$77	81%
Heart Of America Beverage Company	$78	82%
Loren Cook	$80	84%
Springfieldgreene Co Library	$81	85%
Src Holdings Corporation	$82	86%
Ozark Anesthesia Assoc. Inc	$83	87%
Missouri Affiliated School Consortium (Masc)	$85	89%
Justice Furniture And Bedding Co	$86	90%
Ozark County	$86	90%
The Durham Company	$86	90%
Ozarks Cocacola	$87	91%
Flora Farms	$89	93%
Advanced Concrete Technology	$90	95%
Texas Co Memorial Hospital	$129	136%
Bjc Health Solutions	$139	146%

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 $42.
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 Cox Medical Centers 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.