CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Children's Nebraska

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $86
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Children's Nebraska is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.90x the Medicare baseline. Located in 8200 Dodge St, Omaha, NE.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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%)

Insurance Median: $86 (90%)

Ins. Median: $86 (90% 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
Medicaid / KanCare	$22 - $131	23%
Molina (Iowa)	$22 - $53	23%
Wellpoint	$22 - $51	23%
Sanford Health Plan	$64 - $371	67%
UnitedHealthcare	$77 - $354	81%
Wellmark	$79 - $359	83%
Aetna	$84 - $371	88%
Avera	$99 - $137	104%
Ambetter / Centene	$115 - $295	121%
Centivo	$117 - $359	123%
Midlands Choice Chi	$126 - $295	132%
Blue Cross Blue Shield	$138 - $338	145%
Health Partners	$147 - $205	154%
Midlands Choice	$147 - $371	154%
Midlands Choice Elevate	$147 - $338	154%
Avera Health Plan	$359	377%

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 $X.
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 Children's Nebraska 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.