CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sharp Chula Vista Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $251
Cash Discount Price: $304
vs. Medicare Baseline: 2.64x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Sharp Chula Vista Medical Center is $251. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $304. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.64x the Medicare baseline. Located in 751 Medical Center Court, Chula Vista, CA.

Cash / Self-Pay

$304

Average discount available for prompt cash payment at this facility.

Insurance Median

$251

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: $304 (319%)

Insurance Median: $251 (264%)

Cash: $304 (319% of Medicare)

Ins. Median: $251 (264% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 264% of the Medicare baseline (a markup of 164%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$55 - $374	58%
Community Health Group	$58 - $228	61%
UnitedHealthcare	$59 - $332	62%
Blue Cross Blue Shield	$61 - $311	64%
Managed Health Network	$62 - $259	65%
Cigna	$116 - $290	122%
Epic Americas	$117 - $278	123%
Health Net	$117 - $407	123%
Blue Shield	$124 - $316	130%
Kaiser	$198 - $311	208%
Medi-Cal	$198 - $241	208%
California Health And Wellness	$199 - $387	209%
County Medical Services	$199 - $407	209%
Interplan	$208 - $340	219%
Indian Health Council	$210 - $280	221%
Molina	$234 - $374	246%
San Diego Pace	$247 - $374	259%
Allianz Global Assistance	$253 - $286	266%
Multiplan	$276	290%
Humana	$282 - $316	296%
Medicare (plans)	$282 - $387	296%

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 $304.
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 Sharp Chula Vista Medical Center 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.