CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Incline Village Community Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $530
Cash Discount Price: $589
vs. Medicare Baseline: 5.57x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Incline Village Community Hospital is $530. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $589. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 5.57x the Medicare baseline. Located in 880 Alder Street, Incline Village, NV.

Cash / Self-Pay

$589

Average discount available for prompt cash payment at this facility.

Insurance Median

$530

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: $589 (619%)

Insurance Median: $530 (557%)

Cash: $589 (619% of Medicare)

Ins. Median: $530 (557% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 557% of the Medicare baseline (a markup of 457%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$27 - $2,984	28%
Medicare (plans)	$39 - $1,293	41%
UnitedHealthcare	$70 - $2,984	74%
Ca Hlth And Wellness - All Plans	$77 - $3,382	81%
Healthnet - All Plans	$77 - $3,150	81%
Aetna	$89 - $2,918	93%
Prominence Healthfirst - All Plans	$89 - $2,918	93%
Admar Multiplan - All Plans	$91 - $2,984	96%
First Health - All Plans	$91 - $2,984	96%
Great West/One Health - All Plans	$91 - $2,984	96%
Hometown Hp - All Plans	$91 - $2,984	96%
Humana	$91 - $2,984	96%
Interplan - All Plans	$91 - $2,984	96%
Multiplan - All Plans	$91 - $2,984	96%
Phcs - All Plans	$91 - $2,984	96%
Cigna	$93 - $3,051	98%
Beech Street/Capp Care - All Plans	$96 - $3,150	101%
Uhn - All Plans	$96 - $3,150	101%
Sierra Health - All Plans	$98 - $3,217	103%

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 $589.
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 Incline Village Community 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.