Office visit, established patient (20-29 min)
Facility: University Medical Center of Princeton at Plainsboro
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $308
- Cash Discount Price: $385
- vs. Medicare Baseline: 3.24x 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 324% of the Medicare baseline (a markup of 224%). 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 |
|---|---|---|
| Charity Care | $36 | 38% |
| Aetna | $36 - $321 | 38% |
| Medicaid / KanCare | $36 - $385 | 38% |
| Horizon Nj Health | $38 | 40% |
| Wellcare | $39 | 41% |
| Magellan | $55 | 58% |
| Amerihealth | $55 | 58% |
| Blue Cross Blue Shield | $77 - $290 | 81% |
| Preferred Health Care Eliance | $100 | 105% |
| Us Family Health Plan | $135 | 142% |
| Claim Watcher | $135 | 142% |
| Horizon Behavioral Health | $144 | 151% |
| Beacon Health Options | $192 | 202% |
| Magnacare | $231 - $270 | 243% |
| Princeton Theological Seminary | $250 | 263% |
| Health Net | $270 | 284% |
| Coventry | $270 | 284% |
| UnitedHealthcare | $289 | 304% |
| Beech Street | $308 - $327 | 324% |
| Intergroup | $308 | 324% |
| Penn Global Medicine Embassy Only | $308 | 324% |
| Intergrated Health Plan | $308 | 324% |
| Allied Trades | $327 | 344% |
| Qualcare | $327 | 344% |
| Ie Shaffer | $327 | 344% |
| Tri-State | $327 | 344% |
| First Managed Care Option | $327 | 344% |
| Total Care Network | $327 | 344% |
| Devon Health Services | $327 | 344% |
| Private Healthcare Systems | $327 | 344% |
| Consumer Health Network | $327 | 344% |
| Personnel Health Program | $385 | 404% |
| Nj Carpenters | $385 | 404% |
| Penn Behavioral Health Corporate Services | $385 | 404% |
| International Pfs | $385 | 404% |
| Life St. Francis | $385 | 404% |
| Cigna | $385 | 404% |
| Elap | $385 | 404% |
| Managed Health Network | $385 | 404% |
| Clover Health Plan | $385 | 404% |
| VA Medical Center | $385 | 404% |
| Centivo | $385 | 404% |
| Compsych | $385 | 404% |
| United Behavioral Health | $385 | 404% |
| Tricare | $385 | 404% |
| Commercial Other | $385 | 404% |
| Concern Plus | $385 | 404% |