CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Tri-City Medical Center

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$77

about 0.8× the $95 Medicare rate · typically $37–$181

modeled estimate · not a bill or quote

What this hospital charges insurers

$24

Below the fair price — a good deal

about $53 under the fair price · 0.3× Medicare

Medicare pays $95 Fair price $77 This hospital $24 Cash price $127 Hospital's list price $211

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

One of the lower prices — 6 of 8 other CA hospitals charge more for the same procedure.

Cheapest $18 Priciest $34

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Office visit, established patient (20-29 min) is about $77 (about 0.8× the $95 Medicare rate). Tri-City Medical Center charges insurers about $24, or about $127 in cash — below the fair price — a good deal. Located in Oceanside, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Kaiser Permanente Humana

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$27 - $164	28%
Blue Cross Blue Shieldmajor	$39 - $212	41%
Aetnamajor	$13 - $250	14%
Cignamajor	$48 - $282	50%
Kaiser Permanentemajor	$23 - $125	24%
Health Net	$20 - $278	21%
Molina	$20 - $107	21%
Providence Health Plan	$20 - $107	21%
+ 3 smaller / regional plans	$16 - $214

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 127), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm Tri-City Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Tri-City Medical Center

Compare: Office visit, established patient (20-29 min) at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.