CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Stanford Health Care

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $244
Cash Discount Price: $341
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Stanford Health Care is $244. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $341. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.56x the Medicare baseline. Located in 300 Pasteur Drive, Stanford, CA.

Cash / Self-Pay

$341

Average discount available for prompt cash payment at this facility.

Insurance Median

$244

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: $341 (358%)

Insurance Median: $244 (256%)

Cash: $341 (358% of Medicare)

Ins. Median: $244 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Health Plan Of San Mateo [31200]	$67 - $84	70%
Cigna	$121 - $143	127%
Beech St [10600]	$164 - $244	172%
Claritev [13400]	$164 - $244	172%
Kaiser Northern Ca [12900]	$164 - $244	172%
Private Healthcare Systems (Phcs) [14200]	$164 - $244	172%
Blue Card (Out Of State) [40000]	$214	225%
Blue Cross Blue Shield	$214 - $346	225%
Shca Comm Intel [20300000]	$214	225%
Aetna	$246	258%
Healthnet Alt Payer [912100000]	$263	276%
Healthnet [12100]	$263	276%
UnitedHealthcare	$285	299%
American Specialty Health Plan Alt Payer [971000000]	$346	363%
Blue Card (Out Of State) - Blue Shield [40200]	$346	363%
Blue Shield Alt Payer [970000000]	$346	363%
Blue Shield [70000]	$346	363%
Psych Blue Shield Alt Payer [970000100]	$346	363%

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 $341.
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 Stanford Health Care 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.