Office visit, established patient (20-29 min)
Facility: Tri Valley Health System
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $167
- Cash Discount Price: $214
- vs. Medicare Baseline: 1.75x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $37 - $410 | 39% |
| Humana | $37 - $329 | 39% |
| Medica Mcr Adv | $37 - $329 | 39% |
| Medica Prime Sol | $37 - $329 | 39% |
| Tricare | $37 - $329 | 39% |
| Wellcare Mcr Adv - All Plans | $37 - $329 | 39% |
| Great Plains Mcr Adv - All Plans | $39 - $345 | 41% |
| Healthy Blue Mcaid - All Plans | $40 - $207 | 42% |
| Molina Mcaid - All Plans | $40 - $207 | 42% |
| Nebraska Total Care-All Plans | $40 - $207 | 42% |
| UnitedHealthcare | $40 - $415 | 42% |
| Amerigroup Mcaid - All Plans | $41 - $212 | 43% |
| Aetna | $57 - $423 | 60% |
| Medica Chi Aco - All Other Plans | $76 - $389 | 80% |
| Medica Chi Open Access | $76 - $389 | 80% |
| Medica Ifb Aco | $76 - $389 | 80% |
| Medica Ifb Open Access | $76 - $389 | 80% |
| Midlands Choice-All Plans | $76 - $389 | 80% |
| Multiplan-All Plans | $82 - $423 | 86% |