CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Uva Health Culpeper Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $134
Cash Discount Price: $117
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Uva Health Culpeper Medical Center is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.41x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$134

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: $117 (123%)

Insurance Median: $134 (141%)

Cash: $117 (123% of Medicare)

Ins. Median: $134 (141% 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
Cigna	$23 - $156	24%
Beacon Health Options [40012]	$30	32%
Commercial Contracted Hb Only [40056]	$31	33%
Commercial Generic [40000]	$31 - $41	33%
Geha [40009]	$34 - $622	36%
UnitedHealthcare	$34 - $773	36%
Commercial Contracted Tpa [40055]	$35 - $41	37%
Umwa [40037]	$41	43%
Aetna	$44 - $139	46%
Healthsmart [40013]	$44	46%
First Health Generic [40033]	$48	50%
Gateway Health Alliance [40034]	$50	53%
Multiplan Generic [40035]	$50 - $178	53%
Vhn Generic [40040]	$50 - $178	53%
Onenet Workers Comp Generic [60010]	$52	55%
Champva [50002]	$66	69%
Tricare	$66	69%
Blue Ridge Pace [10510]	$120	126%
Medicaid / KanCare	$120	126%
Carefirst [30007]	$124	130%
Blue Cross Blue Shield	$134 - $399	141%
HMO Part B [10099]	$134	141%
Humana	$134 - $140	141%
Medicare (plans)	$134 - $138	141%
VA Ccn [99926]	$134 - $138	141%
VA Ccn [99927]	$134 - $138	141%
Veterans Administration [99910]	$138	145%
Sentara Behavioral Health [40052]	$182 - $243	191%
Sentara [40021]	$182 - $243	191%
Kaiser Permenente [40014]	$211	222%

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 $117.
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 Uva Health Culpeper 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.