Office visit, established patient (20-29 min)
Facility: San Gabriel Valley Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $256
- Cash Discount Price: $131
- vs. Medicare Baseline: 2.69x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 269% of the Medicare baseline (a markup of 169%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Allied Physicians | $19 | 20% |
| Emanate Health | $19 | 20% |
| Ahmc Medi-Cal Reciprocity | $24 | 25% |
| Altamed Health Network | $24 | 25% |
| Beverly Hospital | $24 | 25% |
| Brand New Day | $24 - $495 | 25% |
| Healthnet Medi-Cal Non-Contract | $24 | 25% |
| Non Contracting Medi Cal | $24 | 25% |
| Aids Healthcare Foundation | $28 - $330 | 29% |
| Avanti | $28 | 29% |
| Healthy Way La | $28 | 29% |
| Hollywood Presbyterian Adv Med Mcal | $28 | 29% |
| Hollywood Presbyterian Medpoint Mcal | $28 | 29% |
| La Care Health Plan | $28 | 29% |
| Medicaid / KanCare | $28 | 29% |
| Physicians Healthways | $28 - $578 | 29% |
| Care 1St Health Plan | $34 - $536 | 36% |
| Blue Cross Blue Shield | $38 - $156 | 40% |
| Athens Administrators | $57 | 60% |
| Beech Street | $57 - $660 | 60% |
| Health Net | $57 - $479 | 60% |
| Other Non Contracting Workers Comp | $57 | 60% |
| Aetna | $92 - $429 | 97% |
| Ahmc Reciprocity | $111 - $248 | 117% |
| Pacificare Of California | $121 - $270 | 127% |
| Alignment Healthplan | $129 - $289 | 136% |
| Clever Care | $129 - $289 | 136% |
| Health Net Inc | $142 - $318 | 149% |
| Molina Healthcare Of California | $144 - $322 | 151% |
| Pacific Independent Physician Associates | $148 - $330 | 155% |
| UnitedHealthcare | $177 - $412 | 186% |
| Facey Medical | $184 - $412 | 193% |
| Cigna | $188 - $421 | 197% |
| Central Health Plan | $221 - $495 | 232% |
| Community Care Network | $240 - $536 | 252% |
| Choicecare Network | $258 - $578 | 271% |
| Private Healthcare Systems (Phcs) | $258 - $578 | 271% |
| Affiliated Health Fund | $277 - $619 | 291% |
| Private Pay | $300 - $672 | 315% |
| Multiplan | $332 - $742 | 349% |
| Ppo Next | $332 - $742 | 349% |
| Managed Health Network | $369 - $825 | 388% |
| Medi-Cal Sub Acute | $369 - $825 | 388% |
| One Legacy | $369 - $825 | 388% |
| Other Non Contracted Commercial | $369 - $825 | 388% |
| Us Behavioral Health Plan | $369 - $825 | 388% |
| Blue Shield Of California | $437 | 459% |