CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adventist Health Tulare

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $95
Cash Discount Price: $36
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adventist Health Tulare is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.70x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $36 (27%)

Insurance Median: $95 (70%)

Cash: $36 (27% of Medicare)

Ins. Median: $95 (70% 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.

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	$38 - $133	28%
Ccipa Medi-Cal - All Plans	$38	28%
Healthnet Medi-Cal	$38	28%
Medi-Cal	$38	28%
Upn-United Physcn Ntwrk Mcal Profee Only	$38	28%
Aetna	$74	55%
Tricare	$85	63%
Ah Employee Health Plan - All Plans	$93	69%
Incentive Hlth - All Plans	$93	69%
Cigna	$96	71%
UnitedHealthcare	$102	75%
Hs Interplan-All Plans	$106	78%
Cal Forensic Med Grp - All Plans	$110	81%
Healthnet Hmo/Ppo - All Other Plans	$124	91%
Blue Shield Epn	$148	109%
Blue Shield-All Other Plans	$157	116%

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 $36.
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 Tulare 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.