CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Ohiohealth Morrow County Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $90
  • Cash Discount Price: $80
  • vs. Medicare Baseline: 0.95x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Ohiohealth Morrow County Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.95x the Medicare baseline. Located in 651 West Marion Road, Mount Gilead, OH.
Cash / Self-Pay
$80

Average discount available for prompt cash payment at this facility.

Insurance Median
$90

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: $80 (84%)
Insurance Median: $90 (95%)
Cash: $80 (84% of Medicare)
Ins. Median: $90 (95% 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.

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 $44 - $101 46%
Medicare (plans) $44 - $49 46%
UnitedHealthcare $44 - $107 46%
Aetna $45 - $113 47%
Humana $45 - $122 47%
Caresource Marketplace - All Other Plans $56 - $61 59%
Medicaid / KanCare $84 - $86 88%
Amerihealth Caritas - All Plans $87 91%
Medical Mutual Of Ohio Marketplace $90 - $98 95%
Ohiohealthy Network - All Other Plans $90 - $98 95%
Ohiohealthy Preferred $90 - $98 95%
Medical Mutual Of Ohio Comm - All Other Plans $97 - $106 102%
Medical Mutual Of Ohio - Admin Serv $102 - $111 107%
Phcs - All Plans $110 - $121 116%
Cigna $113 - $123 119%
Multiplan - All Plans $114 - $125 120%
Healthstar Comm - All Plans $115 - $126 121%
Beech Street - All Plans $116 - $127 122%
Molina Exchange - All Other Plans $139 146%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 651 West Marion Road, Mount Gilead, OH 43338
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals