CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: AHMC Anaheim Regional Medical Center
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $184
- Cash Discount Price: $461
- vs. Medicare Baseline: 1.93x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at AHMC Anaheim Regional Medical Center is $184. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $461. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.93x the Medicare baseline. Located in 1111 W La Palma Avenue, Anaheim, CA.
Cash / Self-Pay
$461
Average discount available for prompt cash payment at this facility.
Insurance Median
$184
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: $461 (484%)
Insurance Median: $184 (193%)
Cash: $461 (484% of Medicare)
Ins. Median: $184 (193% 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.
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 |
|---|---|---|
| Allied Physicians | $19 | 20% |
| Applecare Medical Group | $19 | 20% |
| Heritage Provider Network | $19 - $32 | 20% |
| Non Contracted Medi-Cal | $19 | 20% |
| Talbert Medical Group | $19 - $55 | 20% |
| Ahmc Reciprocity Agreement | $24 - $155 | 25% |
| Altamed Health Network | $24 | 25% |
| Beverly Hospital | $24 | 25% |
| Brand New Day | $24 - $310 | 25% |
| Health Net | $24 | 25% |
| Healthcare Partners | $24 | 25% |
| Healthy Way La | $24 | 25% |
| Caloptima | $27 - $34 | 28% |
| Monarch Health Plan | $27 - $516 | 28% |
| Aids Health Foundation | $28 | 29% |
| Avanti | $28 | 29% |
| Emanate Health | $28 | 29% |
| Health Net Inc | $28 - $396 | 29% |
| Healthnet Cal Optima Medi-Cal/Healthy Families | $28 | 29% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $28 | 29% |
| Hollywood Presbyterian Medpoint Mcal | $28 | 29% |
| Medi-Cal | $28 | 29% |
| Blue Cross Blue Shield | $30 - $96 | 32% |
| Msi/Medical Services For Indigents | $30 - $52 | 32% |
| Kaiser Foundation Hospitals | $34 | 36% |
| Medical Safety Net Program | $34 | 36% |
| Prospect Health Plan | $34 | 36% |
| Genesis Healthcare Ipa Ancillary | $35 | 37% |
| Netcare Life And Health Insurance | $40 - $129 | 42% |
| Advance Clinical Research Institute | $48 - $155 | 50% |
| Angels Baseball Workers Comp | $48 | 50% |
| Interplan | $51 - $361 | 54% |
| First Health | $55 - $439 | 58% |
| Monarch Healthcare Medical Group | $55 | 58% |
| Orange County Preferred Provider Organization | $55 - $387 | 58% |
| Athens Administrators | $57 | 60% |
| Capp Care | $57 - $387 | 60% |
| Cigna | $57 - $263 | 60% |
| Corvel | $57 - $387 | 60% |
| Marriot Intl | $57 | 60% |
| Non Contracted Workers Comp | $57 | 60% |
| Memorial Healthcare Ipa | $61 - $155 | 64% |
| Prospect Medical Group | $61 | 64% |
| Medical Acquisition Company | $64 - $206 | 67% |
| Affiliated Doctors Of Orange County | $72 - $232 | 76% |
| Medicare (plans) | $80 - $258 | 84% |
| UnitedHealthcare | $80 - $258 | 84% |
| Aetna | $83 - $268 | 87% |
| Davita Heatlhcare Partners Plan Inc | $86 - $279 | 90% |
| Healthcare Partners Commercial | $86 - $279 | 90% |
| Huntington Memorial Hospital | $86 - $279 | 90% |
| Scan Health Plan | $104 - $335 | 109% |
| Affiliated Health Fund | $112 - $361 | 118% |
| Allnet Preferred Provider | $112 - $361 | 118% |
| Care First | $112 - $361 | 118% |
| Private Healthcare Systems | $112 - $361 | 118% |
| Choicecare | $120 - $387 | 126% |
| Multiplan Inc | $120 - $387 | 126% |
| National Provider Network | $128 - $413 | 134% |
| Three Rivers Providers Network | $128 - $413 | 134% |
| Health Payors Organization | $144 - $464 | 151% |
| Non Contracted Commercial | $160 - $516 | 168% |
| Tricare | $160 - $516 | 168% |
| Blue Shield Of California | $355 - $408 | 373% |