CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: NYU Langone Hospitals

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $412
Cash Discount Price: $100
vs. Medicare Baseline: 4.33x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at NYU Langone Hospitals is $412. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 4.33x the Medicare baseline. Located in 550 First Avenue, New York, NY.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$412

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: $100 (105%)

Insurance Median: $412 (433%)

Cash: $100 (105% of Medicare)

Ins. Median: $412 (433% 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 433% of the Medicare baseline (a markup of 333%). 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
Healthfirst	$66 - $72	69%
Healthplus	$66	69%
Ghi	$72 - $12,574	76%
Hip	$72 - $8,427	76%
Medicare (plans)	$72 - $73	76%
Wellcare	$72 - $73	76%
Centerlight	$73 - $75	77%
Hamaspik	$107 - $110	112%
Multiplan	$207 - $1,224	217%
Oscar	$221	232%
Aetna	$236 - $1,570	248%
Oxford	$285 - $786	299%
UnitedHealthcare	$355 - $418	373%
Cigna	$524	550%
1199	$757	795%
Blue Cross Blue Shield	$928 - $1,160	975%
Magnacare	$956 - $13,453	1004%

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 $100.
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 NYU Langone Hospitals 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.