CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Loma Linda University Children's Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $342
Cash Discount Price: $233
vs. Medicare Baseline: 3.59x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Loma Linda University Children's Hospital is $342. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $233. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.59x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$233

Average discount available for prompt cash payment at this facility.

Insurance Median

$342

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: $233 (245%)

Insurance Median: $342 (359%)

Cash: $233 (245% of Medicare)

Ins. Median: $342 (359% 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 359% of the Medicare baseline (a markup of 259%). 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
Inland Empire Health Plan (Iehp)	$40	42%
Kaiser Foundation Hospitals	$46 - $345	48%
Trivalley Medical Group	$100	105%
Adventist Health	$103 - $212	108%
Lluh Dept Of Risk Management	$124	130%
Epic Health Plan	$207	217%
Alpha Care Medical Group	$284 - $439	298%
Global Benefits Group	$310	326%
Temecula Valley Physicians Medical Group	$310	326%
Blue Cross Blue Shield	$317	333%
Cigna	$331 - $383	348%
Networks By Design	$336	353%
Aetna	$339	356%
Molina Healthcare Of Ca	$362	380%
Multiplan	$414	435%
Dignity Health	$439	461%
Galaxy Health	$439	461%
Prime Health Services	$439	461%
Vantage Medical Group	$439	461%
UnitedHealthcare	$570 - $824	599%

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 $233.
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 Loma Linda University Children's Hospital 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.