CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Adventist Health and Rideout

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $102
Cash Discount Price: $54
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Adventist Health and Rideout is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.07x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$102

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: $54 (57%)

Insurance Median: $102 (107%)

Cash: $54 (57% of Medicare)

Ins. Median: $102 (107% 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.

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
Healthnet Mcal	$23 - $75	24%
Kaiser Mcal	$34	36%
Medi-Cal	$34	36%
Bc Mcal	$41	43%
Ca Health And Wellness- All Plans	$43	45%
Celtic Mcaid-All Plans	$43	45%
Blue Cross Blue Shield	$58 - $287	61%
Kaiser Mcr Adv	$58	61%
Tricare	$58	61%
UnitedHealthcare	$58 - $324	61%
Beacon Health Op/Profee Only-All Plans	$67	70%
Aetna	$82 - $264	86%
Healthnet Comm-All Other Plans	$84 - $272	88%
Kaiser-All Other Plans	$88 - $283	92%
Blue Shield Uc Care Members	$93 - $298	98%
Cigna	$99 - $318	104%
First Health-All Plans	$102 - $326	107%
Phcs-All Plans	$102 - $328	107%
Ah Employee Health Plan - All Plans	$104	109%
Interplan-All Plans	$104 - $336	109%
Blue Shield-All Other Plans	$110 - $354	116%
Multiplan-All Plans	$110 - $354	116%
Partnership Hp Mcal -All Plans	$191 - $615	201%

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 $54.
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 Adventist Health and Rideout 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.