CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Boston Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $158
Cash Discount Price: $188
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Boston Medical Center is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $188. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.66x the Medicare baseline. Located in 1 Boston Medical Center Place, Boston, MA.

Cash / Self-Pay

$188

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $188 (197%)

Insurance Median: $158 (166%)

Cash: $188 (197% of Medicare)

Ins. Median: $158 (166% 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
Tufts [8002]	$23 - $61	24%
Cigna	$27 - $354	28%
Corrections [9001]	$61 - $193	64%
Tufts Conncare/Qhp [8020]	$61 - $431	64%
Workers Comp [5002]	$66	69%
Zzzbu Employee Work Comp [5004]	$66	69%
Zzzcity Of Boston Work Comp [5003]	$66	69%
Unicare [8004]	$73	77%
Wellpoint [2034]	$73	77%
Fallon [8008]	$79	83%
Champva [9004]	$145	152%
Tricare	$145	152%
Aetna	$155 - $204	163%
Blue Cross Blue Shield	$155	163%
Humana	$155	163%
Medicare (plans)	$155 - $162	163%
Neighborhood Pace [1206]	$155	163%
Ubh Hphc [8016]	$155	163%
UnitedHealthcare	$155 - $380	163%
Veterans Admin [9003]	$155	163%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$155	163%
Wellcare [1240]	$161	169%
Cca [1215]	$162	170%
Zzzcca Onecare [1216]	$162	170%
Eternalhealth [1227]	$164	172%
Uphams Corner Esp [1213]	$167	175%
Fallon Sco [1126]	$170	179%
Senior Whole Health [1210]	$186	195%
Meritain Health [1023]	$204	214%
Oxford Health [1007]	$380	399%
Oxford Health [2024]	$380	399%
United [2025]	$380	399%
Zzzunited [1008]	$380	399%
Hsn Bad Debt [4003]	$513	539%
Hsn Confidential [4007]	$513	539%
Hsn Dental [4006]	$513	539%
Hsn Partial [4002]	$513	539%
Hsn [4001]	$513	539%

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 $188.
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 Boston Medical Center 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.