CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adventist Health Vallejo

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $105
Cash Discount Price: $28
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adventist Health Vallejo is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.77x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$28

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $28 (21%)

Insurance Median: $105 (77%)

Cash: $28 (21% of Medicare)

Ins. Median: $105 (77% 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
Medi-Cal	$38 - $54	28%
Va Medi-Cal	$54	40%
Blue Shield Behav Hlth	$58 - $112	43%
UnitedHealthcare	$58 - $158	43%
Blue Shield Non-Epn-All Other Plans	$60 - $115	44%
Blue Shield Epn	$61 - $117	45%
Aetna	$68 - $129	50%
Phcs-All Plans	$72 - $136	53%
Western Growers-All Plans	$75 - $144	55%
Healthnet-All Plans	$80 - $152	59%
Interplan-All Plans	$84 - $161	62%
Choicecare-All Plans	$91 - $174	67%
Blue Shield Mcr Adv	$95	70%
Medicare (plans)	$95	70%
Napa County Mcal Child	$95	70%
Tricare	$95	70%
Va Mcr-All Other Plans	$95	70%
Blue Cross Blue Shield	$96 - $183	71%
Cigna	$96 - $198	71%
Beech Street-All Plans	$98 - $186	72%
Ah Employee Health Plan-All Plans	$105 - $171	77%
Kaiser-All Plans	$109 - $208	80%
Health Management Network-All Plans	$110 - $211	81%
Galaxy Network-All Plans	$117 - $223	86%
Three Rivers-All Plans	$117 - $223	86%

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 $28.
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 Vallejo 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.