CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 99213 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$95

about 1.0× the $95 Medicare rate · typically $42–$122

modeled estimate · not a bill or quote

What this hospital charges insurers

$48

Below the fair price — a good deal

about $47 under the fair price · 0.5× Medicare

Medicare pays $95 Fair price $95 This hospital $48 Cash price $146 Hospital's list price $146

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

Lowest price of the 9 OR hospitals we have prices for — a strong deal.

Cheapest $48 Priciest $105

Black dot = this hospital, among the 9 OR hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Office visit, established patient (20-29 min) is about $95 (about 1.0× the $95 Medicare rate). Saint Alphonsus Medical Center Ontario charges insurers about $48, or about $146 in cash — below the fair price — a good deal. Located in Ontario, OR.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$46 - $99	48%
Blue Cross Blue Shieldmajor	$46 - $134	48%
Aetnamajor	$46 - $119	48%
Cignamajor	$46 - $115	48%
Humanamajor	$46 - $63	48%
Kaiser Permanentemajor	$134	141%
Ambetter (Centene)	$48	50%
Clover Health	$46	48%
Dean Health Plan	$120	126%
GEHA	$99 - $100	104%
Health Net	$48 - $119	50%
HealthPartners	$48	50%
Meridian	$46 - $48	48%
Moda Health	$84 - $118	88%
Molina	$48 - $91	50%
PacificSource	$79 - $111	83%
Paramount	$48 - $120	50%
Presbyterian	$46 - $48	48%
SelectHealth	$118 - $143	124%
Tufts Health Plan	$48	50%
WellMed	$46	48%
WellSense	$48	50%
+ 363 smaller / regional plans	$46 - $134

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 12 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 146), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm Saint Alphonsus Medical Center Ontario is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Saint Alphonsus Medical Center Ontario

Compare: Office visit, established patient (20-29 min) at other OR hospitals

Insurance negotiated median for the same procedure, sorted lowest first.