Office visit, established patient (20-29 min)
Facility: Memorial Hospital Pembroke
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $231
- Cash Discount Price: $358
- vs. Medicare Baseline: 2.43x 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 243% of the Medicare baseline (a markup of 143%). 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 |
|---|---|---|
| Community Care Plan | $34 - $90 | 36% |
| Humana | $34 | 36% |
| Wellcare | $35 - $65 | 37% |
| Sunshine | $46 - $3,388 | 48% |
| Florida Community Care | $47 - $75 | 49% |
| Health Sun | $51 - $398 | 54% |
| Amerihealth Caritas | $57 - $85 | 60% |
| UnitedHealthcare | $57 - $227 | 60% |
| Aetna | $61 - $291 | 64% |
| Cigna | $61 - $247 | 64% |
| Oscar | $61 - $200 | 64% |
| Molina | $64 - $95 | 67% |
| Align Senior Care | $66 - $102 | 69% |
| Solis Health Plan | $66 - $96 | 69% |
| Gold Kidney | $69 - $102 | 72% |
| Magellan Healthcare | $74 - $427 | 78% |
| Doctors Healthcare Plans | $75 - $102 | 79% |
| Longevity | $75 | 79% |
| Prime Health Services | $104 - $148 | 109% |
| Employers Choice Network | $110 - $148 | 116% |
| First Health | $110 - $148 | 116% |
| Freedom | $110 | 116% |
| Corvel | $116 - $148 | 122% |
| Gallagher Bassett | $116 - $424 | 122% |
| Employers Health Network | $117 - $175 | 123% |
| Emerging Therapy Solutions | $130 - $398 | 137% |
| Quality Health Management | $134 - $408 | 141% |
| Allianz | $139 - $424 | 146% |
| Axis | $139 - $424 | 146% |
| Desjardins Financial Security Life Assurance Company | $139 - $424 | 146% |
| Global Health Claims | $139 - $450 | 146% |
| Global Medical Management | $139 - $424 | 146% |
| Global Reach Health | $139 - $424 | 146% |
| National Healthcare Solutions | $139 - $424 | 146% |
| Plotkin | $139 - $424 | 146% |
| Quebec Inc | $139 - $424 | 146% |
| Star Healthcare Network | $139 - $424 | 146% |
| Worldwide Managed Care Partners | $139 - $424 | 146% |
| Worldwide Medical Assurance | $139 - $424 | 146% |
| Avmed | $164 - $228 | 172% |
| Carelon | $205 | 215% |
| World Medical Care | $231 - $344 | 243% |
| Dimension Health | $240 - $358 | 252% |
| Evernorth | $285 - $409 | 299% |
| Broward County | $718 - $2,726 | 754% |