CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mary Lanning Healthcare

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $164
Cash Discount Price: $218
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mary Lanning Healthcare is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $218. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.72x the Medicare baseline. Located in 715 N St Joseph Ave, Hastings, NE.

Cash / Self-Pay

$218

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $218 (229%)

Insurance Median: $164 (172%)

Cash: $218 (229% of Medicare)

Ins. Median: $164 (172% 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
Workers Compensation-All Plans	$35 - $136	37%
Tricare	$51	54%
Aetna	$55 - $842	58%
Blue Cross Blue Shield	$55 - $957	58%
Medica Mcr Adv	$55	58%
Ne Total Care Mcr Adv	$55	58%
UnitedHealthcare	$55 - $909	58%
Va Ccn - All Plans	$55	58%
Consociate Inc-All Plans	$85 - $804	89%
Ambetter / Centene	$90 - $246	95%
Midlands Choice-All Plans	$93 - $861	98%
Medica-All Other Plans	$96 - $833	101%
Nhn/Mna-All Plans	$104 - $775	109%
Multiplan-All Plans	$164 - $909	172%
Provider Network Of America-All Plans	$164 - $861	172%

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 $218.
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 Mary Lanning Healthcare 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.