CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St John's Episcopal Hospital at South Shore

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $64
Cash Discount Price: $325
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St John's Episcopal Hospital at South Shore is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $325. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.67x the Medicare baseline. Located in 327 Beach 19Th Street, Far Rockaway, NY.

Cash / Self-Pay

$325

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $325 (341%)

Insurance Median: $64 (67%)

Cash: $325 (341% of Medicare)

Ins. Median: $64 (67% 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.

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	$53 - $143	56%
Vns	$60 - $64	63%
Blue Cross Blue Shield	$62 - $79	65%
Aetna	$64 - $110	67%
Centerlight	$64	67%
Centers Plan For Healthy Living	$64	67%
Elderplan	$64	67%
Emblem Health	$64	67%
Fidelis	$64	67%
Hamaspik	$64	67%
Humana	$64	67%
Longevity	$64	67%
Lucida	$64	67%
Metroplus	$64	67%
UnitedHealthcare	$64 - $210	67%
Village Care Max	$64	67%
Wellcare	$64	67%
Molina	$70	74%

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 $325.
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 St John's Episcopal Hospital at South Shore 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.