CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Physicians Care Surgical Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $102
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.07x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Physicians Care Surgical Hospital is $102. 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 1.07x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$102

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: $102 (107%)
Ins. Median: $102 (107% 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
Aetna $102 107%
Ag Administrators $102 107%
Ag Administrators Inc $102 107%
Allied Benefit Systems $102 107%
Allied Benefits Systems $102 107%
Continental Benefits $102 107%
Coventry $102 107%
Geha $102 107%
Healthez $102 107%
Lucent Health $102 107%
Marpai Health $102 107%
Meritain Health $102 107%
Premier Care Network $102 107%
Trustmark $102 107%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 454 Enterprise Drive, Royersford, PA 19468
  • CMS Rating: No CMS Rating
  • Ownership Type: Physician
  • Hospital Type: Acute Care Hospitals