CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: South Pointe Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $75
Cash Discount Price: $90
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at South Pointe Hospital is $75. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.79x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$75

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: $90 (95%)

Insurance Median: $75 (79%)

Cash: $90 (95% of Medicare)

Ins. Median: $75 (79% 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
Aetna	$30 - $139	32%
Oscar	$42 - $53	44%
Summacare	$48 - $52	50%
Cc Ehp	$54 - $55	57%
Aultcare	$60	63%
UnitedHealthcare	$62 - $86	65%
Paramount	$67	70%
Blue Cross Blue Shield	$68 - $111	71%
Buckeye	$68	71%
Molina	$68	71%
Ohcp	$68	71%
Caresource	$70	74%
Omas	$70	74%
United	$70	74%
Amerihealth	$72	76%
Mmo	$75 - $83	79%
Ohio Healthy	$75	79%
Healthsmart	$76	80%
Php	$83	87%
The Health Plan	$83	87%
Upmc	$83	87%
Gms	$97	102%
Medical Benefit Corp	$97	102%
Quality Care Partners	$97	102%
Consociate Health	$104	109%
Managed Care Services	$104	109%
Cigna	$114	120%
Humana	$118	124%
Frontpath	$125	131%
Multiplan	$125	131%
Tertiary Care Network	$125	131%
Three Rivers	$125	131%

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 $90.
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 South Pointe 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.