CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sheridan Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $213
Cash Discount Price: $184
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Sheridan Memorial Hospital is $213. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $184. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.24x the Medicare baseline. Located in 1401 W 5Th St, Sheridan, WY.

Cash / Self-Pay

$184

Average discount available for prompt cash payment at this facility.

Insurance Median

$213

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: $184 (193%)

Insurance Median: $213 (224%)

Cash: $184 (193% of Medicare)

Ins. Median: $213 (224% 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 224% of the Medicare baseline (a markup of 124%). 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
Humana	$57	60%
Blue Cross Blue Shield	$80 - $201	84%
Pacificsource-All Plans	$171 - $213	180%
Medi-Share Profee Only - All Plans	$175 - $218	184%
Miscellaneous-All Plans	$175 - $218	184%
Cigna	$180 - $225	189%
Wise Provider Network-All Plans	$180 - $225	189%
First Choice Comm - All Plans	$184 - $230	193%
Phcs Multiplan-All Plans	$184 - $230	193%
Three Rivers-All Plans	$184 - $230	193%
Wy School Boards-All Plans	$202	212%
UnitedHealthcare	$207	217%
C1 Employee - All Plans	$218	229%
Casper Opco Llc - All Plans	$218	229%
First Health Comm - All Plans	$218	229%
Ebms - All Plans	$230	242%

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 $184.
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 Sheridan 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.