CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Grossmont Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $309
Cash Discount Price: $362
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Grossmont Hospital is $309. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $362. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.28x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$362

Average discount available for prompt cash payment at this facility.

Insurance Median

$309

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: $362 (267%)

Insurance Median: $309 (228%)

Cash: $362 (267% of Medicare)

Ins. Median: $309 (228% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 228% of the Medicare baseline (a markup of 128%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Molina	$30 - $405	22%
Health Net	$31 - $405	23%
Kaiser	$70 - $405	52%
Epic Americas	$74 - $308	55%
Multiplan	$120 - $314	88%
UnitedHealthcare	$120 - $395	88%
Aetna	$147 - $31,171	108%
Managed Health Network	$151 - $237	111%
Blue Shield	$160 - $376	118%
Humana	$198 - $315	146%
Community Health Group	$235 - $376	173%
County Medical Services	$237 - $370	175%
Cigna	$258 - $346	190%
California Health And Wellness	$279 - $341	206%
Blue Cross Blue Shield	$291 - $56,107	215%
Medi-Cal	$309 - $461	228%
Allianz Global Assistance	$314 - $341	232%
Indian Health Council	$329 - $370	243%
Interplan	$329	243%
Medicare (plans)	$346 - $405	255%
San Diego Pace	$346 - $370	255%

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 $362.
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 Grossmont Hospital 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.