CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Valley Regional Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $244
Cash Discount Price: $543
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Valley Regional Medical Center is $244. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $543. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.56x the Medicare baseline. Located in 100 A Alton Gloor, Brownsville, TX.

Cash / Self-Pay

$543

Average discount available for prompt cash payment at this facility.

Insurance Median

$244

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: $543 (570%)

Insurance Median: $244 (256%)

Cash: $543 (570% of Medicare)

Ins. Median: $244 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Superior Health Plan	$26	27%
Superior	$66 - $124	69%
United	$79 - $319	83%
Aetna	$80 - $301	84%
Texas Workforce Commission	$90 - $170	95%
Healthcare Highways	$96 - $181	101%
Molina Healthcare	$102 - $192	107%
Averde Health	$124 - $234	130%
Curative Administrators	$150 - $284	158%
Blue Cross Blue Shield	$161 - $319	169%
Healthsmart Preferred Care	$162 - $603	170%
First Health	$216 - $408	227%
National Healthcare Solutions	$226 - $426	237%
Southwest Medical	$226 - $426	237%
Cigna	$230 - $303	242%
Coastal Comp	$244 - $461	256%
Total E&P Mexico	$244 - $461	256%
Affiliated Healthcare	$256 - $483	269%
Texas Athletic Network	$300 - $600	315%
Mcm Maxcare	$301 - $568	316%
Pronet Ppo	$301 - $568	316%
Usa Managed Care	$301 - $568	316%
Humana	$303	318%
Beech Street	$338 - $639	355%

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 $543.
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 Valley Regional Medical Center 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.