CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Adventist Health Sierra Vista

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $297
Cash Discount Price: $58
vs. Medicare Baseline: 3.12x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Adventist Health Sierra Vista is $297. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.12x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$58

Average discount available for prompt cash payment at this facility.

Insurance Median

$297

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: $58 (61%)

Insurance Median: $297 (312%)

Cash: $58 (61% of Medicare)

Ins. Median: $297 (312% 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 312% of the Medicare baseline (a markup of 212%). 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	$58 - $488	61%
Cencal Mcr Adv - All Other Plans	$58	61%
Tricare	$58	61%
UnitedHealthcare	$58 - $315	61%
Hpn-Heritage Prov Ntwrk-All Plans	$62 - $311	65%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$76	80%
Ah Employee Health Plan - All Plans	$105	110%
Nbd-Ntwrks By Design Exclus-All Other Plans	$106 - $528	111%
Nbd-Ntwrks By Design Non-Exclus	$106 - $528	111%
Blue Shield Epn	$116 - $359	122%
Blue Shield Epo/Ppo-All Other Plans	$116 - $492	122%
Blue Shield Hmo/Pos	$116 - $447	122%
Medi-Cal	$183 - $915	192%
Cencal Mcal	$209 - $1,043	220%
Blue Shield Promise Mcal	$220 - $1,100	231%
Ccah-Centrl Ca Allince Mcal-All Plans	$238 - $1,190	250%
Coalinga-All Plans	$238 - $1,190	250%

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 $58.
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 Sierra Vista 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.