CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Novant Health Presbyterian Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $181
Cash Discount Price: $153
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Novant Health Presbyterian Medical Center is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $153. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.90x the Medicare baseline. Located in 200 Hawthorne Lane Box 33549, Charlotte, NC.

Cash / Self-Pay

$153

Average discount available for prompt cash payment at this facility.

Insurance Median

$181

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: $153 (161%)

Insurance Median: $181 (190%)

Cash: $153 (161% of Medicare)

Ins. Median: $181 (190% 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
Amerihealth	$33 - $81	35%
Blue Cross Blue Shield	$33 - $330	35%
Carolina Complete	$33 - $80	35%
Nc Department Of Public Safety	$33 - $80	35%
UnitedHealthcare	$33 - $267	35%
Wellcare	$33 - $81	35%
Caresource North Carolina	$62 - $151	65%
Atlantic Corporation Dba Atlantic Packaging	$86 - $211	90%
Aetna	$94 - $366	99%
Cigna	$96 - $236	101%
Amps	$103 - $252	108%
Plotkin Health	$112 - $275	118%
Medcost	$133 - $344	140%
Humana	$135 - $330	142%
Primary Physician Care	$138 - $339	145%
Multiplan	$140 - $344	147%
Phcs	$140 - $344	147%
Employers Choice Network	$181 - $444	190%
Three Rivers Provider Network	$181 - $444	190%

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 $153.
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 Novant Health Presbyterian Medical Center 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.