CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Wellspan Waynesboro Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $316
Cash Discount Price: $422
vs. Medicare Baseline: 3.32x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Wellspan Waynesboro Hospital is $316. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $422. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.32x the Medicare baseline. Located in 501 East Main St, Waynesboro, PA.

Cash / Self-Pay

$422

Average discount available for prompt cash payment at this facility.

Insurance Median

$316

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: $422 (443%)

Insurance Median: $316 (332%)

Cash: $422 (443% of Medicare)

Ins. Median: $316 (332% 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 332% of the Medicare baseline (a markup of 232%). 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
Medicaid / KanCare	$42 - $57	44%
Medicare (plans)	$42 - $172	44%
Highmark	$137 - $527	144%
Aetna	$142 - $467	149%
Upmc	$316	332%
Cigna	$386 - $406	406%
Geisinger	$390	410%
Wellspan_Capital_Blue_Cross	$474	498%
First_Health_Network	$501	526%
United_Healthcare	$503	528%

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 $422.
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 Wellspan Waynesboro 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.