Office visit, established patient (20-29 min)
Facility: Adventist Health Sonora
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $148
- Cash Discount Price: $31
- vs. Medicare Baseline: 1.55x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Bc Mcal | $24 | 25% |
| Celtic Ca Hlth Well Mcal - All Plans | $24 - $47 | 25% |
| Central Ca Alliance Mcal | $24 - $39 | 25% |
| Healthnet Mcal | $24 - $51 | 25% |
| Medi-Cal | $24 - $34 | 25% |
| Central Ca Alliance Ccs Mcal | $36 - $39 | 38% |
| Central Ca Alliance Comm Profee Only-All Other Pla | $36 | 38% |
| Central Ca Alliance Chdp Mcal | $39 - $48 | 41% |
| Aetna | $58 - $229 | 61% |
| Blue Shield Mcare | $58 - $152 | 61% |
| Healthnet Mcr Adv | $58 - $152 | 61% |
| Phs Prime Health Srvcs-All Plans | $58 - $152 | 61% |
| Tricare | $58 - $152 | 61% |
| UnitedHealthcare | $58 - $284 | 61% |
| Ah Employee Health Plan - All Plans | $64 - $274 | 67% |
| Cigna | $71 - $314 | 75% |
| Greatwest Oa/Pos/Hmo | $75 - $280 | 79% |
| Greatwest Ppo - All Other Plans | $75 - $297 | 79% |
| Western Growers/Pinnacle - All Plans | $80 - $221 | 84% |
| Healthnet - All Other Plans | $84 - $289 | 88% |
| Kaiser - All Plans | $92 - $165 | 97% |
| Bc Mcs | $105 - $184 | 110% |
| Bc Non-Mcs - All Other Plans | $105 - $153 | 110% |
| Blue Shield Epn | $109 - $250 | 115% |
| Bc Exchange | $110 - $138 | 116% |
| Blue Shield - All Other Plans | $115 - $251 | 121% |
| Beech Street- All Plans | $116 - $280 | 122% |
| Trpn - Three Rivers Ppo - All Plans | $116 - $264 | 122% |
| Affordable Health - All Plans | $166 - $297 | 174% |
| Interplan - All Plans | $166 - $297 | 174% |
| Multiplan - All Plans | $166 - $297 | 174% |
| Phcs Ppo - All Plans | $166 - $297 | 174% |
| Stanilaus Foundation - All Plans | $175 - $314 | 184% |