CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Adventist Health Vallejo

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $78
Cash Discount Price: $22
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Adventist Health Vallejo is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.82x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$22

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $22 (23%)

Insurance Median: $78 (82%)

Cash: $22 (23% of Medicare)

Ins. Median: $78 (82% 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%
Va Medi-Cal	$34	36%
UnitedHealthcare	$53 - $108	56%
Blue Shield Behav Hlth	$54 - $76	57%
Blue Shield Non-Epn-All Other Plans	$55 - $78	58%
Blue Shield Epn	$56 - $80	59%
Aetna	$62 - $88	65%
Cigna	$62 - $135	65%
Blue Shield Mcr Adv	$65	68%
Medicare (plans)	$65	68%
Napa County Mcal Child	$65	68%
Phcs-All Plans	$65 - $93	68%
Tricare	$65	68%
Va Mcr-All Other Plans	$65	68%
Western Growers-All Plans	$69 - $98	72%
Ah Employee Health Plan-All Plans	$71 - $116	75%
Healthnet-All Plans	$73 - $104	77%
Interplan-All Plans	$77 - $110	81%
Kaiser-All Plans	$78 - $142	82%
Choicecare-All Plans	$83 - $118	87%
Blue Cross Blue Shield	$88 - $124	92%
Beech Street-All Plans	$89 - $127	93%
Health Management Network-All Plans	$101 - $144	106%
Galaxy Network-All Plans	$107 - $152	112%
Three Rivers-All Plans	$107 - $152	112%

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 $22.
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 Vallejo 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.