CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Nemours Children's Hospital, Delaware

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $82
Cash Discount Price: $144
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Nemours Children's Hospital, Delaware is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.86x the Medicare baseline. Located in 1600 Rockland Rd Po Box 269, Wilmington, DE.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $144 (151%)

Insurance Median: $82 (86%)

Cash: $144 (151% of Medicare)

Ins. Median: $82 (86% 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
Keystone First Hlth Plan	$29 - $64	30%
Us Family Health Plan	$33	35%
Celtic Transplant For De First Health	$50	53%
UnitedHealthcare	$53 - $90	56%
Wellpoint Maryland	$53	56%
Kidz Partners	$54	57%
Health Partners	$56	59%
Upmc	$57	60%
Fidelis	$58	61%
Aetna	$61 - $84	64%
Blue Cross Blue Shield	$63 - $127	66%
Priority Partners John Hopkins	$71	75%
Six Degrees Health Transplant	$72	76%
Cigna	$79 - $91	83%
Great West-One Health Plan	$79 - $91	83%
Ambetter / Centene	$82	86%
Amerihealth Caritas Delaware	$82	86%
Geisinger Health Plan	$86	90%
Integra Administrative Group	$86	90%
National Transplant Network (Ntn)	$94	99%
Six Degrees Health	$94	99%
Star Healthcare Network	$94	99%
Life Trac Solid Organ And Bmt Transplant	$101	106%
Tricare	$135	142%
First Health Network	$137	144%
Insurance Administrators Of America	$137	144%
Interlink Transplant Network	$137	144%
Multiplan	$137	144%
Preferred Healthcare	$137	144%
Private Healthcare Systems	$137	144%
Three Rivers Provider Network	$137	144%
Celtic Transplant	$144	151%
Carefirst Md Community Health Plan	$319	335%

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 $144.
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 Nemours Children's Hospital, Delaware 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.