Office visit, established patient (20-29 min)
Facility: Washington Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $568
- Cash Discount Price: $354
- vs. Medicare Baseline: 5.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 597% of the Medicare baseline (a markup of 497%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Kaiser Medi-Cal | $24 - $34 | 25% |
| Medi-Cal | $34 | 36% |
| Alameda Alliance Mcr Adv | $59 - $64 | 62% |
| Alameda Alliance Ppo-All Other Plans | $59 - $268 | 62% |
| Health Net Sr Plus Hmo | $62 | 65% |
| Blue Cross Blue Shield | $63 - $645 | 66% |
| Aetna | $64 - $634 | 67% |
| Blue Shield Mcr Adv | $64 | 67% |
| Brand New Day Mcr Adv - All Plans | $64 - $118 | 67% |
| Canopy Mcr Adv | $64 | 67% |
| Central Hlth Mcr Adv - All Plans | $64 | 67% |
| Humana | $64 - $804 | 67% |
| Kaiser Mcr Adv | $64 | 67% |
| On Lok Senior Health Services-All Plans | $64 | 67% |
| Tricare | $64 | 67% |
| UnitedHealthcare | $64 - $772 | 67% |
| Va (Triwest Ccn)-All Plans | $64 | 67% |
| Health Net/Healthy Family/Aim | $179 | 188% |
| Canopy-All Other Plans | $455 | 478% |
| Blue Shield Eppo | $471 | 495% |
| Kaiser - All Other Plans | $482 | 506% |
| Healthnet Comm - All Other Plans | $538 | 565% |
| Cigna | $555 - $714 | 583% |
| Blue Shield Hmo | $601 | 631% |
| Pacific Health Alliance Epo | $625 | 657% |
| Standford Health Services-All Plans | $625 | 657% |
| County Of Santa Clara-All Plans | $670 | 704% |
| Blue Shield Ppo - All Other Plans | $697 | 732% |
| Pacific Foundation Epo | $714 | 750% |
| Preferred Health Network-All Plans | $757 | 795% |
| Corvel-All Plans | $759 | 797% |
| Interplan B-2 Ppo | $759 | 797% |
| Masonic Homes Ppo-All Plans | $759 | 797% |
| Multiplan Ppo-All Plans | $759 | 797% |
| Pacific Health Alliance Ppo-All Other Plans | $759 | 797% |
| Interplan B-4 Ppo-All Other Plans | $786 | 826% |
| Cna (Mailhandlers)-All Plans | $804 | 845% |
| First Health -All Plans | $804 | 845% |
| Pacific Foundation Ppo-All Other Plans | $804 | 845% |
| Phcs/Private Healthcare Systems-All Plans | $804 | 845% |
| Three Rivers Provider Network-All Plans | $804 | 845% |
| Beech Street-All Plans | $848 | 891% |