CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Lucie Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $433
Cash Discount Price: $2,027
vs. Medicare Baseline: 3.19x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at St Lucie Medical Center is $433. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,027. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.19x the Medicare baseline. Located in 1800 Se Tiffany Ave, Port Saint Lucie, FL.

Cash / Self-Pay

$2,027

Average discount available for prompt cash payment at this facility.

Insurance Median

$433

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: $2,027 (1495%)

Insurance Median: $433 (319%)

Cash: $2,027 (1495% of Medicare)

Ins. Median: $433 (319% 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 319% of the Medicare baseline (a markup of 219%). 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
Corvel Corporation	$87 - $185	64%
Careworks (Rockport)	$89 - $189	66%
Prime Health	$89 - $189	66%
Aetna	$122 - $686	90%
Blue Cross Blue Shield	$122 - $551	90%
Optimum	$152 - $197	112%
Freedom Health	$197 - $366	145%
Simply Healthcare Plans	$297	219%
Oscar	$336	248%
Health Sun Health Plan	$377 - $487	278%
Simply Healthcare	$415	306%
Molina	$434 - $617	320%
Sunshine State Health Plan	$451 - $583	333%
Cigna	$601 - $802	443%
United Ppo	$778 - $1,005	574%
United	$796 - $1,028	587%
Humana	$845 - $914	623%
Avmed	$884	652%
Plotkin Health	$884 - $1,142	652%
Prime Health Sherriff	$884 - $1,142	652%
Multiplan	$1,326 - $1,942	978%

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 $2,027.
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 St Lucie Medical Center 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.