CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Fairfield Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $112
Cash Discount Price: $72
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Fairfield Medical Center is $112. 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 1.18x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $112 (118%)

Cash: $72 (76% of Medicare)

Ins. Median: $112 (118% 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
Oscar	$53 - $17,500	56%
Medical Mutual	$68 - $33,500	71%
Blue Cross Blue Shield	$78 - $26,250	82%
Medicaid / KanCare	$84	88%
Molina	$84 - $168	88%
UnitedHealthcare	$84 - $136	88%
Caresource	$85	89%
Humana	$87 - $50,000	91%
Amerihealth Caritas Ohio	$88	92%
Buckeye Community Health	$88	92%
Aetna	$99 - $110	104%
The Health Plan	$104 - $116	109%
Allied Benefit Systems	$105 - $116	110%
Meritain Health	$105 - $116	110%
Quality Care Partners/Ohio Ppo Connect	$109 - $120	115%
The Ohio State Health Plan	$116 - $129	122%
Cigna	$124 - $138	130%
Ohio Healthy	$142 - $157	149%
Multiplan	$143 - $159	150%
Miscellaneous Plans	$151 - $167	159%

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 Fairfield 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.