CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Temple University Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $75
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Temple University Hospital is $75. 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 0.79x the Medicare baseline. Located in 3401 North Broad Street, Philadelphia, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$75

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: $75 (79%)

Ins. Median: $75 (79% 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
Blue Cross Blue Shield	$14 - $175	15%
Cigna	$16 - $71	17%
Oscar Health	$24 - $88	25%
Aetna	$30 - $140	32%
Innovage	$36 - $130	38%
Geisinger	$39 - $142	41%
Health Partners Plans	$40	42%
Amerihealth Caritas	$42	44%
Prime Health Services	$43 - $156	45%
UnitedHealthcare	$49 - $176	51%
Occunet	$50 - $182	53%
Magellan Health	$57	60%
Gateway Health Plan	$74	78%
Upmc Health Plan	$77	81%
Pennsylvania Health And Wellness	$78	82%
Keystone First	$86	90%

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 Temple University Hospital 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.