CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: The McDowell Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $181
Cash Discount Price: $436
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at The McDowell Hospital is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $436. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.90x the Medicare baseline. Located in 430 Rankin Drive P O Box 730, Marion, NC.

Cash / Self-Pay

$436

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: $436 (458%)

Insurance Median: $181 (190%)

Cash: $436 (458% 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
Blue Cross Blue Shield	$58 - $172	61%
United	$59 - $224	62%
Amerihealth	$60	63%
Wellcare	$60	63%
Partners Health Management	$61	64%
Vaya Health	$61	64%
Apex Health	$87	91%
Aetna	$117 - $315	123%
Oscar	$189	199%
Caresource	$192	202%
Medcost	$194 - $371	204%
Amerihealth Caritas	$205	215%
Magellan	$262	275%
Magellan Behavioral Health	$262	275%
Multiplan	$349	367%
Avalon Administrative Services	$371	390%
Prime Health	$384 - $393	403%

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 $436.
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 The McDowell 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.