CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adventist Health and Rideout

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $130
Cash Discount Price: $64
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adventist Health and Rideout is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.96x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $64 (47%)

Insurance Median: $130 (96%)

Cash: $64 (47% of Medicare)

Ins. Median: $130 (96% 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.

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	$30 - $86	22%
Kaiser Mcal	$54	40%
Medi-Cal	$54	40%
Bc Mcal	$63	46%
Beacon Health Op/Profee Only-All Plans	$64	47%
Ca Health And Wellness- All Plans	$67	49%
Celtic Mcaid-All Plans	$67	49%
Kaiser Mcr Adv	$85	63%
Tricare	$85	63%
UnitedHealthcare	$85 - $375	63%
Blue Cross Blue Shield	$86 - $333	63%
Aetna	$105 - $305	77%
Healthnet Comm-All Other Plans	$108 - $314	80%
Kaiser-All Other Plans	$112 - $328	83%
Blue Shield Uc Care Members	$118 - $346	87%
Cigna	$126 - $368	93%
First Health-All Plans	$130 - $378	96%
Phcs-All Plans	$130 - $380	96%
Interplan-All Plans	$133 - $389	98%
Blue Shield-All Other Plans	$141 - $410	104%
Multiplan-All Plans	$141 - $410	104%
Ah Employee Health Plan - All Plans	$153	113%
Partnership Hp Mcal -All Plans	$244 - $713	180%

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 $64.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.