CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Kings County Hospital Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $125
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.31x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Kings County Hospital Center is $125. 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 1.31x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$125

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: $125 (131%)
Ins. Median: $125 (131% 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
United $35 - $504 37%
Healthfirst $37 - $134 39%
Aetna $40 - $257 42%
Local 1199 $55 - $455 58%
United Behavioral Health $57 - $67 60%
Carelon $62 - $348 65%
Affinity $64 - $132 67%
Amidacare $73 - $455 77%
Blue Cross Blue Shield $73 - $428 77%
Centerlight $73 - $267 77%
Elderplan $73 - $348 77%
Fidelis $73 - $132 77%
Centers Plan For Healthy Living $76 80%
Hamaspik $77 81%
Wellcare $79 - $321 83%
Oscar $95 - $614 100%
Metroplus $126 132%
Oxford $267 - $410 280%
Emblem $319 - $374 335%
Magnacare $320 - $401 336%
Carelon (Amida Care) $428 450%
Multiplan $428 450%
Villagecare Max $455 478%
Vnsny $455 478%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 451 Clarkson Avenue, Brooklyn, NY 11203
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Government - Local
  • Hospital Type: Acute Care Hospitals