CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Island Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $115
Cash Discount Price: $150
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Island Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.21x the Medicare baseline. Located in 1211 24Th Street, Anacortes, WA.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $150 (158%)

Insurance Median: $115 (121%)

Cash: $150 (158% of Medicare)

Ins. Median: $115 (121% 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
Humana	$41 - $212	43%
Kaiser Mcr Adv	$41 - $200	43%
Samish Indian Health - All Plans	$41 - $203	43%
Swinomish Indian Health - All Plans	$41 - $203	43%
Tricare	$41 - $203	43%
Premera Mcr Adv	$43 - $214	45%
Regence Mcr Adv	$43 - $216	45%
Chpw Mcaid - All Plans	$44 - $200	46%
Coordinated Care Mcaid - All Plans	$45 - $200	47%
Molina Mcaid - All Plans	$52 - $200	55%
Multiplan - All Plans	$52 - $212	55%
Kaiser Comm - All Other Plans	$54 - $112	57%
Aetna	$57 - $238	60%
Cigna	$58 - $200	61%
UnitedHealthcare	$61 - $212	64%
First Health - All Plans	$62 - $212	65%
Premera Comm - All Other Plans	$63 - $166	66%
First Choice - All Plans	$69 - $212	72%
Aarp Mcr Adv - All Plans	$72 - $203	76%
Regence Comm - All Other Plans	$72 - $188	76%
Amerigroup Mcaid - All Plans	$74 - $212	78%

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 $150.
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 Island 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.