CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mercy Medical Center

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$220

about 2.3× the $95 Medicare rate · typically $79–$437

modeled estimate · not a bill or quote

What this hospital charges insurers

$433

Well above the fair price

about $213 over the fair price · 4.6× Medicare

Medicare pays $95 Fair price $220 This hospital $433 Cash price $303 Hospital's list price $569

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

Highest price of the 9 OR hospitals we have prices for — worth calling around.

Cheapest $48 Priciest $433

Black dot = this hospital, among the 9 OR hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $220 (about 2.3× the $95 Medicare rate). Mercy Medical Center charges insurers about $433, or about $303 in cash — well above the fair price. Located in Roseburg, OR.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $220. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$346 - $621	363%
Blue Cross Blue Shieldmajor	$317 - $607	333%
Aetnamajor	$326 - $658	342%
Cignamajor	$305 - $570	320%
Health Net	$387 - $694	407%
Moda Health	$265 - $577	278%
PacificSource	$305 - $548	320%
+ 2 smaller / regional plans	$346 - $702

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 303), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm Mercy Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercy Medical Center

Compare: Office visit, established patient (20-29 min) at other OR hospitals

Insurance negotiated median for the same procedure, sorted lowest first.