CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: City of Hope National Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $193
Cash Discount Price: $258
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at City of Hope National Medical Center is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $258. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.03x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$258

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $258 (271%)

Insurance Median: $193 (203%)

Cash: $258 (271% of Medicare)

Ins. Median: $193 (203% 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 203% of the Medicare baseline (a markup of 103%). 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
Health Net	$21 - $302	22%
Heritage Provider Network	$26 - $180	27%
Inland Empire	$41 - $206	43%
Cal Optima	$42 - $68	44%
Blue Cross Blue Shield	$97 - $180	102%
Blue Shield Covca	$119	125%
Prime Healthcare Keenan	$119 - $247	125%
Facey	$120	126%
UnitedHealthcare	$144 - $278	151%
Blue Shield	$152 - $231	160%
Cigna	$169	178%
Blue Shield Promise	$180	189%
Cencal	$206	216%
La Care Health	$206	216%
Kaiser	$232	244%
Aetna	$258	271%
Gold Coast	$258	271%
Molina	$258 - $335	271%
Healthcare Partners	$299	314%
St. Joseph Heritage	$309	325%
Primecare Medical Network	$335	352%
First Health	$397	417%
Phcs Multiplan	$464	487%

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 $258.
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 City of Hope National 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.