CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Lafayette Regional Health Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $178
  • Cash Discount Price: $514
  • vs. Medicare Baseline: 1.87x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Lafayette Regional Health Center is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $514. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.87x the Medicare baseline. Located in 1500 State Street, Lexington, MO.
Cash / Self-Pay
$514

Average discount available for prompt cash payment at this facility.

Insurance Median
$178

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: $514 (540%)
Insurance Median: $178 (187%)
Cash: $514 (540% of Medicare)
Ins. Median: $178 (187% 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.

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
Nhc Advantage $39 - $156 41%
Healthyblue $41 - $165 43%
United $52 - $370 55%
Aetna $54 - $720 57%
Universal Healthcare $54 - $214 57%
Humana $70 - $354 74%
College Park Family Care Center $89 - $354 93%
Oha Network $103 - $411 108%
Cigna $118 - $587 124%
Multiplan $161 - $642 169%
Coventry $164 - $657 172%
Coventry Kc Mo $164 - $657 172%
Cco, Inc. $175 - $699 184%
Corvel Corporation $175 - $699 184%
Focus Healthcare Mgmt, Inc $186 - $741 195%
Blue Cross Blue Shield $206 - $823 216%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1500 State Street, Lexington, MO 64067
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Critical Access Hospitals