CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mon Health Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $111
Cash Discount Price: $111
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mon Health Medical Center is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.17x the Medicare baseline. Located in 1200 Jd Anderson Drive, Morgantown, WV.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $111 (117%)

Insurance Median: $111 (117%)

Cash: $111 (117% of Medicare)

Ins. Median: $111 (117% 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
Gateway_Health_Plan	$35	37%
Unison_Plan	$35	37%
Maryland_Physicians_Care_Plan	$52 - $213	55%
Blue Cross Blue Shield	$53 - $272	56%
Geha_Plan	$55 - $295	58%
The_Health_Plan_Peia_Plan	$56	59%
Aetna	$57 - $243	60%
Medicare (plans)	$57	60%
Paramount_Elite_Plan	$57	60%
Uhc_Onenet_Ppo_Plan	$57 - $295	60%
Uhc_Options_Ppo_Plan	$57 - $283	60%
Uhc_Plan	$57 - $274	60%
Umwa_Plan	$57	60%
Health_South_Mountain_View_Plan	$64	67%
The_Health_Plan_Murray_Energy_Commercial_Aso_Plan	$69 - $243	72%
Upmc__Plan	$74 - $295	78%
Humana	$76 - $274	80%
Zelis_Group_Health_Plan	$104	109%
Zelis_Other_Plan	$104	109%
Cigna	$107 - $274	112%
Seven_Corners_Plan	$115	121%
Acpn_Plan	$125 - $274	131%
The_Health_Plan_Plan	$262	275%
Mon_County_Commission_Plan	$274	288%
Health_Payors_Organization_Plan	$280	294%
Multiplan_Phcs_Plan	$289	304%
Mutual_Of_Omaha_Plan	$289	304%
Three_Rivers_Plan	$295	310%

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 $111.
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 Mon Health 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.