CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: OHSU Hospital and Clinics

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $225
Cash Discount Price: $236
vs. Medicare Baseline: 2.36x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at OHSU Hospital and Clinics is $225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $236. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.36x the Medicare baseline. Located in 3181 Sw Sam Jackson Park Road, Portland, OR.

Cash / Self-Pay

$236

Average discount available for prompt cash payment at this facility.

Insurance Median

$225

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: $236 (248%)

Insurance Median: $225 (236%)

Cash: $236 (248% of Medicare)

Ins. Median: $225 (236% 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 236% of the Medicare baseline (a markup of 136%). 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
Community Health Plan Of Washington	$28 - $268	29%
Kaiser Foundation Hospitals	$70 - $837	74%
Moda	$72 - $860	76%
Samaritan Health Plan	$80 - $767	84%
Blue Cross Blue Shield	$87 - $381	91%
Care Oregon	$87 - $837	91%
Pacific Source	$88 - $1,085	92%
Tuality Health	$94 - $907	99%
Coventry First Health	$109 - $1,046	115%
First Choice	$110 - $1,057	116%
Health Net Health Plan Of Oregon, Inc.	$112 - $1,080	118%
Aetna	$113 - $1,088	119%
Medicare (plans)	$119	125%
Providence Health Plan	$123 - $1,186	129%
Cigna	$133 - $1,275	140%
Molina Exchange	$145 - $1,395	152%

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 $236.
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 OHSU Hospital and Clinics 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.