CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Cheshire Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $149
Cash Discount Price: $72
vs. Medicare Baseline: 1.57x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Cheshire Medical Center is $149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.57x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$149

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: $72 (76%)

Insurance Median: $149 (157%)

Cash: $72 (76% of Medicare)

Ins. Median: $149 (157% 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 Caritas Nh	$23 - $70	24%
Wellsense Health Plan	$26 - $94	27%
Granite State Health Plan	$31 - $70	33%
Harvard Pilgrim Health Care Of Ne	$40 - $151	42%
Aetna	$66 - $226	69%
Ambetter / Centene	$68 - $94	71%
Blue Cross Blue Shield	$68 - $263	71%
Cigna	$68 - $223	71%
Martin'S Point Generations Advantage	$68 - $94	71%
Martin'S Point Health Care	$68 - $94	71%
Mvp	$68 - $223	71%
UnitedHealthcare	$68 - $251	71%
Wellcare Health Plans	$68 - $94	71%
Maine Community Health Options	$85 - $149	89%
Tufts Health Plan	$120 - $212	126%
First Health/Hcvm	$160 - $281	168%
Phcs	$169 - $298	178%
Mass General Brigham Health Plan	$188 - $331	197%

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 $72.
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 Cheshire 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.