CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Shirley Ryan Abilitylab

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $166
Cash Discount Price: $153
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Shirley Ryan Abilitylab is $166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $153. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.74x the Medicare baseline. Located in 355 E Erie St, Chicago, IL.

Cash / Self-Pay

$153

Average discount available for prompt cash payment at this facility.

Insurance Median

$166

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: $153 (161%)

Insurance Median: $166 (174%)

Cash: $153 (161% of Medicare)

Ins. Median: $166 (174% 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
Cigna	$65	68%
Blue Cross Blue Shield	$119 - $367	125%
Health Care Services Corporation	$122	128%
Hfn	$129 - $230	136%
Corvel Corporation	$133	140%
Coventry Workers Comp	$133	140%
Multiplan	$133	140%
Aetna	$136 - $367	143%
Personalcare Insurance Of Il/Firsthealth Grp Corp/Coventryhealth And Life Insurance Co	$136 - $217	143%
State Of Illinois	$136	143%
Uic Physician Group	$140	147%
Uic Physician Group-Campuscare	$140	147%
Union Health Service	$143	150%
UnitedHealthcare	$147	154%
Affordable Health Care Concepts	$153	161%
Loyola University Physician Foundation	$166	174%
Paradigm Health Corporation	$166	174%
University Of Chicago Practice Plan	$166	174%
Advocate And Advocate Health Partners	$178	187%
Gallagher Benefit Administrators	$191	201%
Health Care Services Corporation D/B/A Hmo Illinois	$199	209%
Unicare Life And Health Insurance	$199	209%
Private Healthcare Systems	$204	214%
Resurrection Health Care Preferred	$204	214%
Cofinity Aka Ppom	$217	228%
Health Payors Organization	$217	228%
Health Care Services Corporation Dba Managed Care Network Preferred	$227	238%
Healthnetwork	$242	254%
Meridian Health Plan	$255	268%
County Care	$367	386%

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 $153.
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 Shirley Ryan Abilitylab 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.