CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Adventist Health Vallejo

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $96
Cash Discount Price: $27
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Adventist Health Vallejo is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.82x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$27

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $27 (23%)

Insurance Median: $96 (82%)

Cash: $27 (23% of Medicare)

Ins. Median: $96 (82% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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
UnitedHealthcare	$53 - $159	45%
Blue Shield Behav Hlth	$54 - $112	46%
Blue Shield Non-Epn-All Other Plans	$55 - $116	47%
Blue Shield Epn	$56 - $117	48%
Medi-Cal	$57 - $82	48%
Aetna	$62 - $129	53%
Phcs-All Plans	$65 - $137	55%
Western Growers-All Plans	$69 - $144	59%
Healthnet-All Plans	$73 - $153	62%
Interplan-All Plans	$77 - $162	65%
Blue Shield Mcr Adv	$80	68%
Medicare (plans)	$80	68%
Napa County Mcal Child	$80	68%
Tricare	$80	68%
Va Mcr-All Other Plans	$80	68%
Va Medi-Cal	$82	70%
Choicecare-All Plans	$83 - $174	71%
Ah Employee Health Plan-All Plans	$88 - $144	75%
Blue Cross Blue Shield	$88 - $203	75%
Beech Street-All Plans	$89 - $187	76%
Cigna	$92 - $199	78%
Kaiser-All Plans	$96 - $209	82%
Health Management Network-All Plans	$101 - $212	86%
Galaxy Network-All Plans	$107 - $224	91%
Three Rivers-All Plans	$107 - $224	91%

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 $27.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Vallejo is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.