CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: El Centro Regional Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $181
Cash Discount Price: $151
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at El Centro Regional Medical Center is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.90x the Medicare baseline. Located in 1415 Ross Avenue, El Centro, CA.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$181

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: $151 (159%)

Insurance Median: $181 (190%)

Cash: $151 (159% of Medicare)

Ins. Median: $181 (190% 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
Blue Cross Blue Shield	$58 - $313	61%
Brand New Day Comm - All Other Plans	$58	61%
Brand New Day Mcr	$58	61%
Healthnet Mcr Adv	$58	61%
Molina Mcr Adv	$58	61%
Scp Managed Care - All Plans	$58	61%
Tricare	$58	61%
UnitedHealthcare	$58 - $176	61%
Easy Choice Mcr Adv-All Plans	$64	67%
Healthnet Hmo	$72	76%
Cdcr Correctional-All Plans	$75	79%
Aetna	$80 - $155	84%
Pacificare-All Plans	$112 - $218	118%
Mulitplan Primary - All Other Plans	$123 - $239	129%
Cigna	$136 - $264	143%
Blue Shield-All Plans	$137 - $247	144%
Multiplan Comp	$145 - $282	152%
Trident - All Plans	$154 - $299	162%
Healthnet Comm-All Other Plans	$163 - $317	171%
Humana	$168 - $327	176%
Ahccs/Medi-Cal Misc - All Plans	$181 - $352	190%
Brand New Day Mcal	$181 - $352	190%
Medi-Cal	$181 - $352	190%
Molina Exchange - All Other Plans	$181 - $352	190%
Ambetter / Centene	$186 - $363	195%
Molina Mcal	$199 - $387	209%

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 $151.
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 El Centro Regional 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.