Price Checker / CPT 99213
CPT 99213 — Office o/p est low 20 min
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$57
What Medicare pays in a hospital/ASC setting
$95
What Medicare pays in a physician's office
$1,790
Based on 22 hospital(s) in our database
What do these numbers mean?
The Medicare rateis what the federal government determines is a fair payment for this procedure. It's based on the Relative Value Unit (RVU) system, which accounts for physician work, practice expense, and malpractice cost. Hospitals and providers often charge 3-20x this amount. If your bill is significantly higher than the Medicare rate, you may have grounds to negotiate.
Hospital Charges for CPT 99213
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Arroyo Grande Community Hospital Arroyo Grande, CA | $351 | — | 1050429% |
| Dominican Hospital Santa Cruz, CA | $2,421 | — | 1050429% |
| Henderson Hospital Henderson, KY | $170 | — | 355218% |
| McLaren Port Huron , MI | $29,772 | $14,886 | 31176% |
| PeaceHealth Ketchikan Medical Center , AK | $250 | — | 5914% |
| Phelps Health , MO | $1,075 | — | 2549% |
| Mercy Hospital Carthage , AR | $1,527 | $993 | 1504% |
| Hutchinson Hospital , MN | $1,000 | $470 | 951% |
| Hoke Hospital , NC | $229 | — | 586% |
| Fairmont Hospital , CA | $532 | $266 | 459% |
| RCG Taft Street , IN | $310 | $310 | 226% |
| UPMC Western Psychiatric , PA | $260 | $208 | 173% |
| Connally Memorial Health Centers - Main Campus Floresville, TX | $109 | — | 131% |
| Connally Memorial Health Centers - North Campus Floresville, TX | $109 | — | 98% |
| Lindner Center of Hope , OH | $175 | $103 | 84% |
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About CPT 99213
CPT code 99213 refers to “Office o/p est low 20 min”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $57 in a facility (hospital or ambulatory surgery center) and $95in a non-facility (physician's office) setting.
These rates are set by CMS (Centers for Medicare & Medicaid Services) and represent what the government considers a fair payment for this service. While commercial insurance typically pays somewhat more than Medicare, many hospitals charge significantly higher amounts — sometimes 10-50x the Medicare rate.
What to do if you were overcharged
- Upload your bill— we'll identify this code and compare it against the rates shown above.
- Get a dispute letter— citing the Medicare rate and your hospital's own published pricing data.
- Negotiate or let us handle it — 25% of savings, no savings = no fee.