CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Loma Linda University Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $448
Cash Discount Price: $306
vs. Medicare Baseline: 4.71x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Loma Linda University Medical Center is $448. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $306. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 4.71x the Medicare baseline. Located in 11234 Anderson St, Loma Linda, CA.

Cash / Self-Pay

$306

Average discount available for prompt cash payment at this facility.

Insurance Median

$448

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: $306 (321%)

Insurance Median: $448 (471%)

Cash: $306 (321% of Medicare)

Ins. Median: $448 (471% 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 471% of the Medicare baseline (a markup of 371%). 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
Inland Empire Health Plan (Iehp)	$41	43%
Kaiser Foundation Hospitals	$46 - $454	48%
Trivalley Medical Group	$100	105%
Adventist Health	$136 - $279	143%
Lluh Dept Of Risk Management	$136	143%
Blue Shield Of California	$271 - $415	285%
Epic Health Plan	$272	286%
Riverside University Health System	$272	286%
Blue Cross Blue Shield	$329 - $399	346%
Alpha Care Medical Group	$374 - $578	393%
Global Benefits Group	$408	429%
Temecula Valley Physicians Medical Group	$408	429%
Aetna	$413	434%
Cigna	$435 - $503	457%
Networks By Design	$442	464%
Molina Healthcare Of Ca	$476	500%
Multiplan	$510	536%
Central Health Plan	$544	571%
UnitedHealthcare	$570 - $824	599%
Dignity Health	$578	607%
Galaxy Health	$578	607%
Prime Health Services	$578	607%
Vantage Medical Group	$578	607%
Health Management Network	$612	643%

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 $306.
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 Loma Linda University 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.