CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Alice Peck Day Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $105
Cash Discount Price: $86
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Alice Peck Day Memorial Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.10x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $86 (90%)

Insurance Median: $105 (110%)

Cash: $86 (90% of Medicare)

Ins. Median: $105 (110% 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	$42 - $105	44%
Blue Cross Blue Shield	$45 - $204	47%
Harvard Pilgrim	$57 - $199	60%
Ambetter / Centene	$66	69%
UnitedHealthcare	$66 - $165	69%
Tufts	$67 - $168	70%
Nh Healthy Families	$69	72%
Cigna	$70 - $187	74%
Commercial Generic	$70 - $175	74%
Connecticut General	$70 - $175	74%
Klais	$70 - $177	74%
Aetna	$82 - $206	86%
Mvp	$83 - $208	87%
Coventry Health	$86 - $218	90%
Coventry Health Wc	$86 - $218	90%
Humana	$95 - $238	100%
Wellpoint	$200	210%

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 $86.
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 Alice Peck Day Memorial 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.