CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Metropolitan Hospital Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $321
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.37x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Metropolitan Hospital Center is $321. 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 3.37x the Medicare baseline. Located in 1901 First Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$321

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: $321 (337%)

Ins. Median: $321 (337% 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 337% of the Medicare baseline (a markup of 237%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
United	$35 - $504	37%
Aetna	$40 - $257	42%
United Behavioral Health	$57 - $67	60%
Healthfirst	$58 - $134	61%
Carelon	$62 - $348	65%
Amidacare	$73 - $455	77%
Wellcare	$79 - $321	83%
Fidelis	$105	110%
Oscar	$110 - $614	116%
Metroplus	$126	132%
Centerlight	$267	280%
Oxford	$267 - $410	280%
Emblem	$319 - $374	335%
Magnacare	$320 - $401	336%
Elderplan	$348	366%
Blue Cross Blue Shield	$428	450%
Carelon (Amida Care)	$428	450%
Multiplan	$428	450%
Local 1199	$455	478%
Villagecare Max	$455	478%
Vnsny	$455	478%

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 $X.
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 Metropolitan Hospital 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.