CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Englewood Hospital and Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $106
Cash Discount Price: $59
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Englewood Hospital and Medical Center is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.11x the Medicare baseline. Located in 350 Engle St, Englewood, NJ.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $59 (62%)

Insurance Median: $106 (111%)

Cash: $59 (62% of Medicare)

Ins. Median: $106 (111% 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
Horizon New Jersey Health - Dsnp	$11 - $75	12%
Wellcare_755	$12 - $80	13%
Aetna	$13 - $502	14%
Americhoice_756	$14 - $92	15%
Amerigroup_754	$15 - $100	16%
Emblem_762	$35	37%
Blue Cross Blue Shield	$63 - $592	66%
Multiplan	$73 - $500	77%
UnitedHealthcare	$73 - $1,021	77%
Oxford_741	$77 - $516	81%
Amerihealth_757	$79 - $531	83%
Hip Health Plan	$84 - $613	88%
Horizon	$89 - $637	93%
Cigna	$91 - $614	96%
Magnacare_763	$91 - $613	96%
Magnacare_769	$91 - $613	96%
Health Care Support_787	$99 - $664	104%
Qualcare_752	$100 - $675	105%
Qualcare	$102 - $684	107%
Emblem_734	$106 - $715	111%
Magnacare_768	$106 - $715	111%
Magnacare_770	$106 - $715	111%
Bergen	$114 - $766	120%
Coventry	$114 - $766	120%
Heathnet Federal Services	$114 - $766	120%
Magnacare	$122 - $817	128%
Qualcare_783	$7,783	8176%

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 $59.
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 Englewood Hospital and 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.