Office visit, established patient (20-29 min)
Facility: Ann & Robert H Lurie Childrens Hospital of Chicago
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $355
- Cash Discount Price: $311
- vs. Medicare Baseline: 3.73x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 373% of the Medicare baseline (a markup of 273%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Psychealth Ltd | $28 | 29% |
| Medicare (plans) | $75 - $2,656 | 79% |
| Mercycare Health | $164 | 172% |
| Cigna | $186 - $315 | 195% |
| Aetna | $222 - $348 | 233% |
| La Rabida Childrens Hospital | $222 | 233% |
| Beacon Health Options | $222 | 233% |
| Blue Cross Blue Shield | $249 - $355 | 262% |
| Centegra | $266 | 279% |
| Independent Physicians at Mercy | $266 | 279% |
| West Suburban Health Providers | $311 | 327% |
| Ui Health | $311 | 327% |
| Methodist First Choice | $311 | 327% |
| Imagine Health | $311 | 327% |
| St. Francis | $311 | 327% |
| Health Plus | $311 | 327% |
| Presence Health Partners | $311 | 327% |
| Advanced Physicians Association IPA | $311 | 327% |
| Northwest Community Healthcare | $311 | 327% |
| Shriners Hospital | $333 | 350% |
| Swedish Covenant Physician Partners | $333 | 350% |
| Magellan | $355 - $900 | 373% |
| American Psych Systems | $355 | 373% |
| Macneal Health | $355 | 373% |
| Health Alliance | $355 | 373% |
| Healthlink Inc. | $366 | 384% |
| Principal Healthcare | $377 | 396% |
| Hfn Inc | $377 - $400 | 396% |
| Cofinity | $377 | 396% |
| St. Elizabeth | $377 | 396% |
| Humana | $377 | 396% |
| Preferred Health Network | $391 | 411% |
| Sagamore Health Network | $391 | 411% |
| First Health | $391 | 411% |
| Healthstar | $391 | 411% |
| Beech Street | $400 | 420% |
| Private Health Care System | $400 | 420% |
| Benchmark Health | $400 | 420% |
| Security Health Plan | $400 | 420% |
| Swedish American | $400 | 420% |
| Employer's Coalition on Health | $400 | 420% |
| Wellmark/Healthnetwork | $408 | 429% |
| Multiplan | $422 | 443% |
| Health Smart | $422 | 443% |
| Integrated Health Plan | $422 | 443% |
| Wea Insurance Group | $422 | 443% |
| National Provider Network | $422 | 443% |
| UnitedHealthcare | $599 - $643 | 629% |
| Unicare | $3,678 - $8,500 | 3864% |