CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Grossmont Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $253
Cash Discount Price: $304
vs. Medicare Baseline: 2.66x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Grossmont Hospital is $253. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $304. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.66x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$304

Average discount available for prompt cash payment at this facility.

Insurance Median

$253

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%)

Cash / Self-Pay: $304 (319%)

Insurance Median: $253 (266%)

Cash: $304 (319% of Medicare)

Ins. Median: $253 (266% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 266% of the Medicare baseline (a markup of 166%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$22 - $407	23%
San Diego Pace	$26 - $407	27%
Managed Health Network	$59 - $276	62%
Cigna	$62 - $282	65%
Health Net	$116 - $320	122%
Blue Cross Blue Shield	$117 - $290	123%
Blue Shield	$117 - $320	123%
Allianz Global Assistance	$120 - $387	126%
Interplan	$120 - $282	126%
UnitedHealthcare	$120 - $217	126%
Indian Health Council	$127 - $316	133%
Multiplan	$134 - $332	141%
County Medical Services	$141 - $296	148%
Molina	$141 - $280	148%
Community Health Group	$208 - $332	219%
Kaiser	$234 - $316	246%
Medicare (plans)	$247 - $259	259%
Medi-Cal	$249 - $290	262%
Humana	$253 - $296	266%
California Health And Wellness	$311	327%

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 $304.
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 Grossmont 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.