CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: San Antonio Regional Hospital
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $135
- Cash Discount Price: $165
- vs. Medicare Baseline: 1.00x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at San Antonio Regional Hospital is $135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.00x the Medicare baseline. Located in 999 San Bernardino Road, Upland, CA.
Cash / Self-Pay
$165
Average discount available for prompt cash payment at this facility.
Insurance Median
$135
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$135.6
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $165 (122%)
Insurance Median: $135 (100%)
Cash: $165 (122% of Medicare)
Ins. Median: $135 (100% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $135.6 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 | $54 | 40% |
| Kaiser Medi-Cal | $56 | 41% |
| Healthnet Medi-Cal | $57 | 42% |
| Alpha Care Mg Mcal/Hlthy Kids | $59 | 44% |
| Heritage Prov Ntwrk/Regal Mcal | $59 | 44% |
| Ambetter / Centene | $60 | 44% |
| Molina Medi-Cal | $62 | 46% |
| Blue Cross Blue Shield | $63 - $5,494 | 46% |
| Iehp Mcal | $70 | 52% |
| Tricare | $85 | 63% |
| Blue Shield Mcr Adv | $86 | 63% |
| Caremore Mcr Adv - All Plans | $86 | 63% |
| Choice Phycn Ntwrk Mcr Adv-All Other Plans | $86 | 63% |
| Healthnet Mcr Adv | $86 | 63% |
| Humana | $86 | 63% |
| Iehp Mcr Adv | $86 | 63% |
| Inter Valley Hp Mcr Adv- All Plans | $86 | 63% |
| Kindred Mcr Adv-All Plans | $86 | 63% |
| Molina Mcr Adv | $86 | 63% |
| Scan Health Plan Mcr Adv-All Plans | $86 | 63% |
| Universal Care - All Plans | $86 | 63% |
| Zelis Mcr Adv | $91 | 67% |
| Kasiser Mcr Adv | $93 | 69% |
| Imperial Health Mcr Adv-All Plans | $95 | 70% |
| Epic Health Plan - All Other Plans | $99 | 73% |
| Choice Phycn Ntwrk Op Only | $108 | 80% |
| Molina Exchange-All Other Plans | $112 | 83% |
| Aetna | $117 - $330 | 86% |
| Blue Shield Hmo Pos / Calpers Ppo | $119 | 88% |
| Iehp Comm - All Other Plans | $125 | 92% |
| Blue Shield Epo Ppo - All Other Plans | $128 | 94% |
| Redlands Employee | $130 | 96% |
| Redlands Hmo-All Other Plans | $135 | 100% |
| Prime Health - All Plans | $151 | 111% |
| Pc Inland Valley Scan | $165 | 122% |
| Pc Inland Valley-All Other Plans | $165 | 122% |
| UnitedHealthcare | $165 - $2,060 | 122% |
| Coventry Ccn/First Hlth - All Plans | $182 | 134% |
| Healthnet - All Other Plans | $207 | 153% |
| Choicecare Ntwrk-All Plans | $238 | 176% |
| Multiplan/Phcs - All Plans | $238 | 176% |
| Kaiser Comm - All Other Plans | $241 | 178% |
| Networks By Design - All Plans | $248 | 183% |
| Zelis Comm-All Other Plans | $248 | 183% |
| Foundation Inland Epo-All Other Plans | $264 | 195% |
| Foundation Inland Ppo | $280 | 206% |
| Health Payors - All Plans | $297 | 219% |
| Interplan - All Plans | $297 | 219% |
| Wellcare/Easy Choice-All Plans | $323 | 238% |
| Alpha Care Mg Mcr Adv | $330 | 243% |
| Central Hlth Plan Mcr Adv-All Plans | $330 | 243% |
| Epic Health Plan Mcr Adv | $330 | 243% |
| Prospect Hp-All Plans | $330 | 243% |
| Providence Clevercare Mcr Adv | $330 | 243% |
| Heritage Prov Ntwrk/Regal Mcr Adv | $335 | 247% |
| Clever Care Mcr Adv - All Plans | $346 | 255% |
| La Salle Hp Mcr Adv-All Plans | $346 | 255% |
| Alpha Care Mg-All Other Plans | $412 | 304% |
| Providence Oscar-All Other Plans | $478 | 353% |
| Heritage Prov Ntwrk/Regal - All Other Plans | $606 | 447% |
| Cigna | $4,459 | 3288% |