CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Bay Area Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $241
Cash Discount Price: $205
vs. Medicare Baseline: 2.53x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Bay Area Hospital is $241. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $205. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.53x the Medicare baseline. Located in 1775 Thompson Road, Coos Bay, OR.

Cash / Self-Pay

$205

Average discount available for prompt cash payment at this facility.

Insurance Median

$241

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: $205 (215%)

Insurance Median: $241 (253%)

Cash: $205 (215% of Medicare)

Ins. Median: $241 (253% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 253% of the Medicare baseline (a markup of 153%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Southwest Oregon Ipa - All Plans	$47	49%
Healthnet Mcaid	$57	60%
Healthnet Mcr Adv	$61	64%
Moda Hlth Mcr Adv	$62	65%
Moda Beacon - All Other Plans	$153	161%
Nasomah Hlth Grp - All Plans	$157 - $170	165%
Providence Pebb	$218	229%
Ods Ppo/Pos - All Plans	$220	231%
Pacificsource - All Plans	$222 - $241	233%
Moda Connexus/Synergy	$233 - $253	245%
First Choice - All Plans	$238 - $258	250%
Aetna	$241 - $261	253%
Cigna	$241 - $261	253%
Providence - All Other Plans	$243 - $264	255%
Healthnet Comm- All Other Plans	$249 - $270	262%
UnitedHealthcare	$249 - $270	262%
Blue Cross Blue Shield	$937 - $1,017	984%

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 $205.
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 Bay Area 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.