CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Atlanticare Regional Medical Center - City Campus

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $254
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 2.67x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Atlanticare Regional Medical Center - City Campus is $254. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.67x the Medicare baseline. Located in 1925 Pacific Avenue, Atlantic City, NJ.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$254

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%)
Insurance Median: $254 (267%)
Ins. Median: $254 (267% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 267% of the Medicare baseline (a markup of 167%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Americhoice $42 44%
UnitedHealthcare $42 - $229 44%
Wellcare $44 46%
Horizon $45 - $225 47%
Self Pay $48 50%
Health Partners Plan $80 84%
Amerigroup $84 88%
Magnacare $129 - $290 136%
Cigna $135 - $162 142%
Devoted Health Plan $161 169%
Evernorth $161 - $756 169%
Qualcare Commercial $161 169%
Great West Life $162 170%
Aetna $185 - $266 194%
Amerihealth $207 - $271 217%
Active Care Plus $209 220%
First Mco $209 220%
Mutual Of Omaha $209 220%
Qualcare Wc $209 220%
Consumer Health Network (Chn) $225 - $290 236%
Donio Trucking $225 236%
Devon/ Ullicare $242 254%
Oxford $242 254%
Coventry Health Care $258 271%
Private Healthcare System (Phcs) $258 271%
Blue Cross Blue Shield $265 278%
Health Payors Org $274 288%
Health South $274 288%
Metrahealth Of Nj $274 288%
Prime Health Services $274 288%
Three Rivers Provider Network (Trpn) $274 288%
Active Care Nj Pip $290 305%
Beech Street $290 305%
Choice Care $290 305%
Department Of Corrections $290 305%
Galaxy Health Network $290 305%
Health Network Inc $290 305%
Intergroup Preferred Program $290 305%
Mcs Commercial $290 305%
Metracomp $290 305%
Multiplan $290 305%
Provider Select, Inc $290 305%
Atlantis Health Plan $298 313%
Master Care Inc $298 313%
Advance Healthcare System $306 321%
Community Care Network $306 321%
Health Network America $306 321%
Mcsi/Mrsi No Fault $306 321%
Mcsi/Mrsi Worker'S Comp $306 321%
National Health Plan $306 321%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1925 Pacific Avenue, Atlantic City, NJ 08401
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals