CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Glens Falls Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $81
Cash Discount Price: $144
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Glens Falls Hospital is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.85x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $144 (151%)

Insurance Median: $81 (85%)

Cash: $144 (151% of Medicare)

Ins. Median: $81 (85% 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	$21 - $80	22%
Cdphp	$24 - $140	25%
Medicare (plans)	$46 - $86	48%
Mvp	$46 - $125	48%
UnitedHealthcare	$46 - $120	48%
Aetna	$50 - $114	53%
Emblem Health Ghi	$53 - $86	56%
Tricare	$53 - $86	56%
Blue Cross Blue Shield	$58 - $341	61%
Fidelis	$62 - $315	65%
Cigna	$71 - $125	75%
Blue Shield Highmark	$75 - $94	79%
Blue Shield	$88 - $202	92%
Hamaspik	$140 - $341	147%
Nascentia Health Options	$140 - $341	147%
Magnacare	$162 - $394	170%
Emblem	$173 - $420	182%
Empire Plan Nyship	$184 - $446	193%
Multiplan	$184 - $446	193%
Mvp Commercial	$391 - $422	411%

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 $144.
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 Glens Falls 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.