CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Children's Hosp of Los Angeles
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $13
- Cash Discount Price: $18
- vs. Medicare Baseline: 0.14x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Children's Hosp of Los Angeles is $13. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.14x the Medicare baseline. Located in 4650 Sunset Blvd, Ms 108, Los Angeles, CA.
Cash / Self-Pay
$18
Average discount available for prompt cash payment at this facility.
Insurance Median
$13
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: $18 (19%)
Insurance Median: $13 (14%)
Cash: $18 (19% of Medicare)
Ins. Median: $13 (14% 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.
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 |
|---|---|---|
| Aetna | $10 | 11% |
| Applecare Medical Group | $10 - $18 | 11% |
| Bella Vista Med Grp | $10 - $75 | 11% |
| Blue Shield | $10 - $18 | 11% |
| Centinela Valley Ipa | $10 - $75 | 11% |
| Choice Medical Group | $10 | 11% |
| Community Care | $10 | 11% |
| Culinary Health Fund | $10 - $18 | 11% |
| Global Care Medical Group | $10 - $75 | 11% |
| Good Samaritan Medical Group | $10 | 11% |
| Health Care La Ipa | $10 - $75 | 11% |
| Intl - Global Excel Management | $10 - $36 | 11% |
| Intl - Global Medical Management | $10 | 11% |
| Intl - Quality Health Management | $10 - $18 | 11% |
| Kaiser | $10 | 11% |
| Medicaid / KanCare | $10 - $18 | 11% |
| National Healthcare Solutions | $10 | 11% |
| Premier Physicians Ntwk | $10 - $75 | 11% |
| Access Medical Group | $11 - $59 | 12% |
| Alhambra Hospital Medical Center | $11 - $18 | 12% |
| Allied Pacific Ipa | $11 - $110 | 12% |
| Blue Cross Blue Shield | $11 - $18 | 12% |
| Bright Medical Associates | $11 | 12% |
| Delta Health Systems | $11 | 12% |
| Emanate Health Medical Center Commercial | $11 | 12% |
| Family Care Specialists | $11 - $50 | 12% |
| Heritage Provider Network | $11 - $131 | 12% |
| Los Angeles Medical Center Ipa | $11 - $18 | 12% |
| Managed Care Systems | $11 | 12% |
| Preferred Ipa - Commercial | $11 | 12% |
| Private Hlthcare System | $11 | 12% |
| Sanus Health | $11 | 12% |
| Self-Pay | $11 | 12% |
| Seoul Medical Group | $11 | 12% |
| Sierra Health And Life Insurance Company | $11 | 12% |
| Southern Atlantic Medical Group Mmc | $11 - $18 | 12% |
| UnitedHealthcare | $11 - $18 | 12% |
| Ventura County Health Plan | $11 | 12% |
| Axis Services International | $12 | 13% |
| Calvo Selectcare | $12 | 13% |
| Cedar Sinai Med Grp | $12 | 13% |
| Citrus Valley Phys Grp | $12 | 13% |
| Embassy - Saudi Arabia | $12 | 13% |
| Intl - Aixin Life Insurance Co | $12 - $18 | 13% |
| Intl - Concierge Healthcare Services | $12 | 13% |
| Intl - Erv Travel Services | $12 - $13 | 13% |
| Intl - Msh China Enterprise Services | $12 | 13% |
| Lakewood Health Plan | $12 | 13% |
| Marian Health Services | $12 | 13% |
| Plotkin Health | $12 | 13% |
| Prime Health Services | $12 | 13% |
| Redlands Community Hospital | $12 - $65 | 13% |
| Seaside Health Plan | $12 - $18 | 13% |
| Serra Community Med Clinic - Commercial | $12 | 13% |
| Star Healthcare Network Commercial | $12 | 13% |
| Angeles Ipa | $13 - $128 | 14% |
| Beaver Medical Group | $13 | 14% |
| Korean American Med Grp | $13 | 14% |
| Memorialcare Med Foundation | $13 | 14% |
| Multiplan | $13 | 14% |
| Primecare Medical Network | $13 | 14% |
| Associated Hispanic Physicians Ipa | $14 - $18 | 15% |
| Embassy - All Others | $14 | 15% |
| Embassy - Kuwait | $14 | 15% |
| Hispanic Physician Ipa | $14 - $18 | 15% |
| Interlink Health Services | $14 | 15% |
| Prospect Medical Group | $14 | 15% |
| Self-Pay International | $14 | 15% |
| Accountable Health | $18 | 19% |
| Adventist Health Physicians | $18 | 19% |
| Altamed | $18 - $25 | 19% |
| Asian Community Medical Group | $18 | 19% |
| Avalon Ipa | $18 | 19% |
| Beverly Hospital | $18 | 19% |
| Cal Care Ipa | $18 | 19% |
| California Pacific Physicians Medical Group | $18 | 19% |
| Caloptima | $18 | 19% |
| Care 1St | $18 | 19% |
| Cencal Health | $18 | 19% |
| Champus | $18 | 19% |
| Choc Health Alliance | $18 | 19% |
| Community Care Ipa Mmc | $18 | 19% |
| Community Family Care Ipa | $18 | 19% |
| Crown City Medical Group | $18 - $54 | 19% |
| Dignity Health | $18 | 19% |
| El Proyecto Del Barrio | $18 | 19% |
| Employee Health Systems Med Grp | $18 - $54 | 19% |
| Exceptional Care Medical Group | $18 | 19% |
| Family Health Alliance Med Grp | $18 | 19% |
| Gold Coast Health Plan | $18 | 19% |
| Health Net | $18 - $22 | 19% |
| Healthy New Life Medical Corp | $18 | 19% |
| Hollywood Presbyterian Medical Center | $18 | 19% |
| Imperial Health Holdings Medical Group | $18 | 19% |
| Inland Empire Health Plan | $18 | 19% |
| Karing Physicians Medical Group | $18 | 19% |
| Kern Family Health Plan | $18 | 19% |
| La Care | $18 | 19% |
| Mabuhay Medical Group | $18 | 19% |
| Medi-Cal | $18 | 19% |
| Medicare (plans) | $18 | 19% |
| Molina | $18 | 19% |
| Noble Community Medical Associates | $18 | 19% |
| Pacific Alliance Medical Center | $18 - $42 | 19% |
| Point Comfort Underwriters | $18 | 19% |
| Preferred Ipa | $18 | 19% |
| Primary Care And Pediatric Ipa | $18 | 19% |
| Regent Medical Group | $18 | 19% |
| San Judas Med Grp | $18 | 19% |
| Serendib Healthways Mmc | $18 | 19% |
| Serra Community Med Clinic | $18 | 19% |
| Souther California Hosp System - Mmc | $18 | 19% |
| Southland San Gabriel Valley Medical Group | $18 | 19% |
| St Francis Medical Center | $18 | 19% |
| Superior Choice Medical Group | $18 | 19% |
| Valley Presbyterian Hospital | $18 | 19% |
| Watts Healthcare Mmc | $18 | 19% |
| White Memorial Medical Center | $18 | 19% |
| Gemcare Ipa | $60 | 63% |