CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Marinhealth Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $370
Cash Discount Price: $469
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Marinhealth Medical Center is $370. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $469. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.89x the Medicare baseline. Located in 250 Bon Air Road, Greenbrae, CA.

Cash / Self-Pay

$469

Average discount available for prompt cash payment at this facility.

Insurance Median

$370

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: $469 (493%)

Insurance Median: $370 (389%)

Cash: $469 (493% of Medicare)

Ins. Median: $370 (389% 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 389% of the Medicare baseline (a markup of 289%). 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	$64	67%
Brown And Tolan	$64	67%
Healthnet Tailored Network	$64	67%
Kaiser	$64	67%
Marin Cancer Care	$64	67%
Ca Prison Health Care Services	$103	108%
Healthnet Enhancedcare	$167	175%
Provider Network Of America	$306	321%
Canopy	$370	389%
Canopy Hill Physicians	$370	389%
Blue Shield Cpic/Epo	$382	401%
Providers Network Of America	$405	425%
Blue Shield Hmo/Ppo	$424	445%
Hills Blue Shield Hmo/Ppo	$424	445%
Healthnet Hmo/Ppo	$429	451%
Healthnet Hmo/Ppo Hill Physicians	$429	451%
Blue Shield Aco	$440	462%
UnitedHealthcare	$2,330	2448%

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 $469.
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 Marinhealth 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.