CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Adventist Health Tehachapi Valley

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $83
Cash Discount Price: $36
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Adventist Health Tehachapi Valley is $83. 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 $95.19, this hospital’s rate is 0.87x the Medicare baseline. Located in 1100 Magellan, Tehachapi, CA.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $36 (38%)

Insurance Median: $83 (87%)

Cash: $36 (38% of Medicare)

Ins. Median: $83 (87% 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
Medi-Cal	$24 - $34	25%
Universal Ipa Mcal Op/Profee Only	$24 - $34	25%
Kaiser Medi-Cal Ip/Op Only	$34	36%
Bc Mcal	$35	37%
Healthnet Medi-Cal	$42	44%
Khs-Kern Hlth Systm Mcal	$44	46%
Aetna	$45 - $88	47%
Cigna	$58 - $144	61%
Tricare	$58 - $304	61%
Network Providers- All Plans	$63 - $389	66%
Ah Employee Health Plan - All Plans	$64 - $98	67%
Universal Ipa Mcr Adv Op/Profee Only-All Other Pla	$64 - $304	67%
UnitedHealthcare	$66	69%
Oscar Health Plan- All Plans	$67 - $93	70%
Coventry- All Plans	$70 - $166	74%
Western Grwrs/Pinnacle - All Plans	$77 - $81	81%
Blue Shield Epn- All Other Plans	$78 - $108	82%
Healthnet- All Other Plans	$85 - $142	89%
Centivo - All Plans	$87 - $685	91%
Blue Shield Non-Epn	$92 - $114	97%
Klhp-Kern Legacy Epo -All Other Plans	$92	97%
Blue Cross Blue Shield	$106 - $112	111%
Healthnet Mcare	$304	319%
Medicare (plans)	$304	319%
Kaiser Ip/Op Only- All Other Plans	$523	549%

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: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Tehachapi Valley 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.