CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: San Antonio Regional Hospital
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $107
- Cash Discount Price: $138
- vs. Medicare Baseline: 1.12x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at San Antonio Regional Hospital is $107. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.12x the Medicare baseline. Located in 999 San Bernardino Road, Upland, CA.
Cash / Self-Pay
$138
Average discount available for prompt cash payment at this facility.
Insurance Median
$107
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: $138 (145%)
Insurance Median: $107 (112%)
Cash: $138 (145% of Medicare)
Ins. Median: $107 (112% 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 |
|---|---|---|
| Medi-Cal | $34 | 36% |
| Healthnet Medi-Cal | $36 | 38% |
| Kaiser Medi-Cal | $36 | 38% |
| Alpha Care Mg Mcal/Hlthy Kids | $38 | 40% |
| Heritage Prov Ntwrk/Regal Mcal | $38 | 40% |
| Molina Medi-Cal | $40 | 42% |
| Blue Cross Blue Shield | $41 - $5,494 | 43% |
| Iehp Mcal | $45 | 47% |
| Ambetter / Centene | $50 | 53% |
| Tricare | $58 | 61% |
| Blue Shield Mcr Adv | $59 | 62% |
| Caremore Mcr Adv - All Plans | $59 | 62% |
| Choice Phycn Ntwrk Mcr Adv-All Other Plans | $59 | 62% |
| Healthnet Mcr Adv | $59 | 62% |
| Humana | $59 | 62% |
| Iehp Mcr Adv | $59 | 62% |
| Inter Valley Hp Mcr Adv- All Plans | $59 | 62% |
| Kindred Mcr Adv-All Plans | $59 | 62% |
| Molina Mcr Adv | $59 | 62% |
| Scan Health Plan Mcr Adv-All Plans | $59 | 62% |
| Universal Care - All Plans | $59 | 62% |
| Zelis Mcr Adv | $62 | 65% |
| Kasiser Mcr Adv | $63 | 66% |
| Imperial Health Mcr Adv-All Plans | $65 | 68% |
| Choice Phycn Ntwrk Op Only | $74 | 78% |
| Molina Exchange-All Other Plans | $77 | 81% |
| Aetna | $79 - $275 | 83% |
| Epic Health Plan - All Other Plans | $82 | 86% |
| Iehp Comm - All Other Plans | $85 | 89% |
| Redlands Employee | $88 | 92% |
| Redlands Hmo-All Other Plans | $92 | 97% |
| Blue Shield Hmo Pos / Calpers Ppo | $99 | 104% |
| Prime Health - All Plans | $103 | 108% |
| Blue Shield Epo Ppo - All Other Plans | $107 | 112% |
| Pc Inland Valley Scan | $138 | 145% |
| Pc Inland Valley-All Other Plans | $138 | 145% |
| UnitedHealthcare | $138 - $2,060 | 145% |
| Healthnet - All Other Plans | $141 | 148% |
| Coventry Ccn/First Hlth - All Plans | $151 | 159% |
| Kaiser Comm - All Other Plans | $164 | 172% |
| Choicecare Ntwrk-All Plans | $198 | 208% |
| Multiplan/Phcs - All Plans | $198 | 208% |
| Networks By Design - All Plans | $206 | 216% |
| Zelis Comm-All Other Plans | $206 | 216% |
| Foundation Inland Epo-All Other Plans | $220 | 231% |
| Foundation Inland Ppo | $234 | 246% |
| Health Payors - All Plans | $248 | 261% |
| Interplan - All Plans | $248 | 261% |
| Wellcare/Easy Choice-All Plans | $270 | 284% |
| Alpha Care Mg Mcr Adv | $275 | 289% |
| Central Hlth Plan Mcr Adv-All Plans | $275 | 289% |
| Epic Health Plan Mcr Adv | $275 | 289% |
| Prospect Hp-All Plans | $275 | 289% |
| Providence Clevercare Mcr Adv | $275 | 289% |
| Heritage Prov Ntwrk/Regal Mcr Adv | $279 | 293% |
| Clever Care Mcr Adv - All Plans | $289 | 304% |
| La Salle Hp Mcr Adv-All Plans | $289 | 304% |
| Alpha Care Mg-All Other Plans | $344 | 361% |
| Providence Oscar-All Other Plans | $399 | 419% |
| Heritage Prov Ntwrk/Regal - All Other Plans | $505 | 531% |
| Cigna | $4,459 | 4684% |