CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Intermountain Health Garfield Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $162
Cash Discount Price: $128
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Intermountain Health Garfield Memorial Hospital is $162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.70x the Medicare baseline. Located in 200 North 400 East, Panguitch, UT.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$162

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: $128 (134%)

Insurance Median: $162 (170%)

Cash: $128 (134% of Medicare)

Ins. Median: $162 (170% 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.

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
Aetna	$64 - $164	67%
Health Choice Utah	$64 - $152	67%
Healthy U	$64 - $152	67%
Medicare (plans)	$64 - $87	67%
Molina	$64 - $162	67%
Molina Healthcare Of Utah	$64 - $162	67%
Selecthealth	$64 - $162	67%
Triwest	$64 - $88	67%
Uofu	$64 - $162	67%
Tricare	$74 - $88	78%
UnitedHealthcare	$140 - $143	147%
Blue Cross Blue Shield	$162	170%
Byu Athletic Department	$162	170%
Campbell Scientific	$162	170%
Cigna	$162	170%
Deseret Mutual	$162	170%
Emi Health	$162	170%
Franklin County	$162	170%
Health Utah	$162	170%
Hygeia Corporation	$162	170%
Juniper Systems	$162	170%
Lw Miller	$162	170%
Managed Care Administrators, Inc.	$162	170%
Medcare International	$162	170%
Motivhealth	$162	170%
Pehp	$162	170%
Prodegi Corporate Benefit Services, Llc	$162	170%
Springtide	$162	170%
Tanner Llc	$162	170%
Utah State University	$162	170%
Utah Tech University	$162	170%
Wise	$162	170%

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 $128.
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 Intermountain Health Garfield Memorial 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.