CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Adventist Health Tulare

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $64
Cash Discount Price: $25
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Adventist Health Tulare is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.67x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$25

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $25 (26%)

Insurance Median: $64 (67%)

Cash: $25 (26% of Medicare)

Ins. Median: $64 (67% 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.

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
Blue Cross Blue Shield	$24 - $91	25%
Ccipa Medi-Cal - All Plans	$24	25%
Healthnet Medi-Cal	$24	25%
Medi-Cal	$24	25%
Upn-United Physcn Ntwrk Mcal Profee Only	$24	25%
Aetna	$48	50%
Tricare	$58	61%
Cigna	$62	65%
Ah Employee Health Plan - All Plans	$64	67%
Incentive Hlth - All Plans	$64	67%
UnitedHealthcare	$66	69%
Hs Interplan-All Plans	$72	76%
Cal Forensic Med Grp - All Plans	$75	79%
Healthnet Hmo/Ppo - All Other Plans	$84	88%
Blue Shield Epn	$108	113%
Blue Shield-All Other Plans	$114	120%

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 $25.
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 Tulare 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.