CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Cody Regional Health

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $280
Cash Discount Price: $264
vs. Medicare Baseline: 2.94x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Cody Regional Health is $280. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $264. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.94x the Medicare baseline. Located in 707 Sheridan Avenue, Cody, WY.

Cash / Self-Pay

$264

Average discount available for prompt cash payment at this facility.

Insurance Median

$280

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: $264 (277%)

Insurance Median: $280 (294%)

Cash: $264 (277% of Medicare)

Ins. Median: $280 (294% 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 294% of the Medicare baseline (a markup of 194%). 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
Mountain Health - All Plans	$57 - $1,235	60%
Tricare	$57 - $631	60%
Medica Comm - All Other Plans	$63 - $1,235	66%
Pacific Source - All Plans	$83 - $1,235	87%
Blue Cross Blue Shield	$107 - $1,304	112%
Christian Hlthcare - All Plans	$110 - $1,098	116%
Cigna	$124 - $1,089	130%
First Choice Health - All Plans	$124 - $1,235	130%
Humana	$124 - $1,276	130%
Interwest Health Ppo - All Plans	$127 - $1,262	133%
First Health Ntwrk-All Plans	$128 - $1,276	134%
Three Rivers - All Plans	$131 - $1,304	138%
UnitedHealthcare	$131 - $1,276	138%
Rocky Mtn Admin - All Plans	$280 - $1,235	294%

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 $264.
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 Cody Regional Health 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.