CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adventist Health Twin Cities

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $441
Cash Discount Price: $80
vs. Medicare Baseline: 3.25x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adventist Health Twin Cities is $441. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.25x the Medicare baseline. Located in 1100 Las Tablas Rd, Templeton, CA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$441

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $80 (59%)

Insurance Median: $441 (325%)

Cash: $80 (59% of Medicare)

Ins. Median: $441 (325% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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 325% of the Medicare baseline (a markup of 225%). 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	$86 - $496	63%
Cencal Mcr Adv - All Other Plans	$86	63%
Tricare	$86	63%
UnitedHealthcare	$86 - $417	63%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$111	82%
Hpn-Heritage Prov Ntwrk-All Plans	$125 - $421	92%
Blue Shield Epn	$132 - $446	97%
Blue Shield Hmo/Pos	$152 - $513	112%
Ah Employee Health Plan - All Plans	$154	114%
Blue Shield Epo/Ppo - All Other Plans	$178 - $601	131%
Chn-Community Hlth Ntwrk-All Plans	$202 - $681	149%
Nbd-Ntwrks By Design Exlus-All Other Plans	$212 - $716	156%
Nbd-Ntwrks By Design Non-Exlus	$212 - $716	156%
Pacific Health Alliance-All Plans	$330 - $1,115	243%
Medi-Cal	$367 - $1,239	271%
Cencal Mcal	$418 - $1,412	308%
Blue Shield Promise Mcal	$441 - $1,489	325%
Ccah-Centrl Ca Allince Mcal-All Plans	$477 - $1,611	352%
Coalinga-All Plans	$477 - $1,611	352%

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 $80.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Twin Cities is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
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.