CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Atlantic Rehabilitation Institute, LLC

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $127
  • Cash Discount Price: $127
  • vs. Medicare Baseline: 1.33x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Atlantic Rehabilitation Institute, LLC is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.33x the Medicare baseline. Located in 200 Madison Ave, Madison, NJ.
Cash / Self-Pay
$127

Average discount available for prompt cash payment at this facility.

Insurance Median
$127

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: $127 (133%)
Insurance Median: $127 (133%)
Cash: $127 (133% of Medicare)
Ins. Median: $127 (133% 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.

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
Aetna $127 133%
All Savers Cpd $127 133%
Ama Insurance Msg $127 133%
Ambetter / Centene $127 133%
Amerigroup Mgg (Wellpoint As Of 5/1/24) $127 133%
Amerihealth Cpd $127 133%
Amerihealth Mgg $127 133%
Blue Cross Blue Shield $127 133%
Braven Health Cpd $127 133%
Braven Health Mgd $127 133%
Cigna $127 133%
Claim Doc Llc Cpd $127 133%
First Managed Care Wc Cpd $127 133%
Gateway Mgg $127 133%
Medicaid / KanCare $127 133%
Oscar Health Cpd $127 133%
Oxford Health Plan Cpd $127 133%
Oxford Mgg $127 133%
Qualcare Cpd $127 133%
Qualcare Lynx Wc Cpd $127 133%
UnitedHealthcare $127 133%
Upmc For Life Mgg $127 133%
Wellcare Mgg $127 133%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 200 Madison Ave, Madison, NJ 07940
  • CMS Rating: No CMS Rating
  • Ownership Type: N/A
  • Hospital Type: PART A PROVIDER - HOSPITAL