CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Adventist Health Ukiah Valley

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $115
Cash Discount Price: $37
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Adventist Health Ukiah Valley is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.21x the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $37 (39%)

Insurance Median: $115 (121%)

Cash: $37 (39% of Medicare)

Ins. Median: $115 (121% 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
Kaiser Medi-Cal	$24 - $34	25%
Medi-Cal	$24 - $34	25%
Aetna	$51 - $157	54%
Blue Shield Mcr Adv	$58 - $280	61%
Kaiser Mcr Adv	$58 - $280	61%
Tricare	$58 - $280	61%
UnitedHealthcare	$58 - $197	61%
Cigna	$62 - $184	65%
Ah Employee Health Plan - All Plans	$64 - $505	67%
Blue Cross Blue Shield	$66 - $126	69%
Blue Shield Epn-All Other Plans	$70 - $108	74%
Blue Shield Non-Epn	$71 - $114	75%
Western Growers-All Plans	$83 - $105	87%
Healthnet-All Plans	$84 - $135	88%
Mendocino Lcc District-All Plans	$84 - $153	88%
Kaiser-All Other Plans	$103 - $189	108%
Three Rivers-All Plans	$116 - $212	122%
Foundation For Medical Care-All Plans	$138 - $177	145%
Networks By Design-All Plans	$147 - $189	154%
Phcs Multiplan-All Plans	$147 - $189	154%
Interplan-All Plans	$151 - $194	159%
Beech Street-All Plans	$156 - $201	164%
Choice Care-All Plans	$156 - $201	164%
Health Mgmt Network-All Plans	$156 - $201	164%

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 $37.
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 Ukiah Valley 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.