CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Phelps Memorial Health Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $131
Cash Discount Price: $147
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Phelps Memorial Health Center is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.38x the Medicare baseline. Located in 1215 Tibbals St, Holdrege, NE.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $147 (154%)

Insurance Median: $131 (138%)

Cash: $147 (154% of Medicare)

Ins. Median: $131 (138% 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
Va Ccn - All Plans	$55 - $285	58%
UnitedHealthcare	$60 - $286	63%
Aetna	$63 - $286	66%
Blue Cross Blue Shield	$63 - $286	66%
Good Samaritan Mcr Adv - All Plans	$63 - $286	66%
Medica Mcr Adv	$63 - $286	66%
Wellcare Mcr Adv - All Plans	$63 - $286	66%
Molina Mcaid - All Plans	$65 - $164	68%
Three Rivers - All Plans	$66 - $343	69%
Providrs Care/Wppa - All Plans	$73 - $147	77%
Provider Network Of American - All Plans	$82 - $152	86%
Partners Hlth Alliance - All Plans	$96 - $130	101%
6 Degrees Hlth - All Plans	$99 - $130	104%
Medica-All Other Plans	$99 - $153	104%
Midwest Ntwrk Alliance - All Plans	$104 - $155	109%
Ambetter / Centene	$113 - $744	119%
Cpi Benefit Group-All Plans	$132 - $147	139%
Chi Health Partners - All Plans	$140 - $155	147%
First Health - All Plans	$140 - $156	147%

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 $147.
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 Phelps Memorial Health 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.