CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adventist Health St Helena

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $109
Cash Discount Price: $32
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adventist Health St Helena is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.80x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $32 (24%)

Insurance Median: $109 (80%)

Cash: $32 (24% of Medicare)

Ins. Median: $109 (80% 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	28%
Tricare	$91	67%
Cigna	$96	71%
Ah Employee Health Plan - All Plans	$100	74%
UnitedHealthcare	$102	75%
Interplan-All Plans	$109	80%
Kaiser-All Other Plans	$109	80%
Phcs-All Plans	$117	86%
Aetna	$119	88%
Western Growers-All Plans	$130	96%
Blue Shield Epn-All Other Plans	$164	121%
Blue Cross Blue Shield	$173	128%
Blue Shield Non-Epn	$173	128%
Health Management Network-All Plans	$180	133%
Three Rivers-All Plans	$191	141%

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 $32.
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 St Helena 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.