CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Boston Medical Center-Brighton

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $160
Cash Discount Price: $75
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Boston Medical Center-Brighton is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $75. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.68x the Medicare baseline. Located in 736 Cambridge Street, Nevins Building, Brighton, MA.

Cash / Self-Pay

$75

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

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: $75 (79%)

Insurance Median: $160 (168%)

Cash: $75 (79% of Medicare)

Ins. Median: $160 (168% 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
Blue Cross Blue Shield	$29 - $160	30%
Cigna	$34	36%
Tufts [8002]	$34	36%
Harvard Pilgrim Health Care [8001]	$58	61%
Unicare [8004]	$73	77%
Wellpoint [2034]	$73	77%
Fallon [8008]	$79	83%
Aetna	$122 - $160	128%
Meritain Health [1023]	$122	128%
Humana	$160	168%
Medicare (plans)	$160 - $168	168%
Neighborhood Pace [1206]	$160	168%
Senior Whole Health [1210]	$160	168%
Ubh Hphc [8016]	$160	168%
United Community Plan [1202]	$160	168%
UnitedHealthcare	$160	168%
Veterans Admin [9003]	$160	168%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$160	168%
Cca [1215]	$168	176%
Zzzcca Onecare [1216]	$168	176%
Eternalhealth [1227]	$169	178%
Hsn Bad Debt [4003]	$475	499%
Hsn Confidential [4007]	$475	499%
Hsn Dental [4006]	$475	499%
Hsn Partial [4002]	$475	499%
Hsn [4001]	$475	499%

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 $75.
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-Brighton 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.