CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Massachusetts General Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $187
Cash Discount Price: $233
vs. Medicare Baseline: 1.96x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Massachusetts General Hospital is $187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $233. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.96x the Medicare baseline. Located in 55 Fruit Street, Boston, MA.

Cash / Self-Pay

$233

Average discount available for prompt cash payment at this facility.

Insurance Median

$187

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: $233 (245%)

Insurance Median: $187 (196%)

Cash: $233 (245% of Medicare)

Ins. Median: $187 (196% 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
Mgb Health Plan [150001]	$89 - $153	93%
Cigna	$114 - $265	120%
UnitedHealthcare	$123 - $272	129%
Champva [160001]	$145 - $273	152%
Tricare	$145 - $273	152%
Tufts Health Plan [170001]	$145 - $273	152%
Molina [1014]	$150	158%
Tufts Health Public Plans [1013]	$150	158%
Blue Cross Blue Shield	$153	161%
Commonwealth Care Alliance [1007]	$153	161%
Elder Services [1037]	$153	161%
Fallon Health [1008]	$153	161%
Health New England [1034]	$153 - $256	161%
Humana	$153	161%
Martin'S Point [160007]	$153	161%
Medicare (plans)	$153	161%
Wellsense [1003]	$153	161%
Aetna	$158 - $268	166%
Harvard Pilgrim [120001]	$166 - $175	174%
Harvard Pilgrim Alternate [120002]	$183 - $275	192%
Centers Of Excellence [1026]	$187 - $239	196%
International Commercial [140001]	$187 - $272	196%
Phcs Multiplan [1022]	$221 - $256	232%

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 $233.
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 Massachusetts General Hospital 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.