CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Sterling Regional Medcenter

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $375
Cash Discount Price: $472
vs. Medicare Baseline: 2.77x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Sterling Regional Medcenter is $375. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $472. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.77x the Medicare baseline. Located in 615 Fairhurst St, Sterling, CO.

Cash / Self-Pay

$472

Average discount available for prompt cash payment at this facility.

Insurance Median

$375

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: $472 (348%)

Insurance Median: $375 (277%)

Cash: $472 (348% of Medicare)

Ins. Median: $375 (277% 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 277% of the Medicare baseline (a markup of 177%). 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
Aetna	$110 - $796	81%
Banner Health	$122 - $265	90%
Blue Cross Blue Shield	$122 - $695	90%
Healthspring Life & Health Insurance Company, Inc.	$122 - $265	90%
Medica	$122 - $713	90%
Medicare (plans)	$122 - $265	90%
Assist Health Group	$147 - $318	108%
Pinnacol Assurance Workers Comp	$192 - $416	142%
UnitedHealthcare	$229 - $811	169%
Denver Health Medical Plan	$239 - $518	176%
Apostrophe, Inc.	$356 - $770	263%
First Choice Health Network	$356 - $770	263%
First Choice Of The Midwest	$375 - $813	277%
Hue Health, Inc	$375 - $813	277%
Rocky Mountain Health Plans	$375 - $813	277%
Multiplan	$383 - $830	282%

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 $472.
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 Sterling Regional Medcenter 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.