CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Loring Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $242
Cash Discount Price: $255
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Loring Hospital is $242. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $255. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.78x the Medicare baseline. Located in 211 Highland Avenue Po Box 217, Sac City, IA.

Cash / Self-Pay

$255

Average discount available for prompt cash payment at this facility.

Insurance Median

$242

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: $255 (188%)

Insurance Median: $242 (178%)

Cash: $255 (188% of Medicare)

Ins. Median: $242 (178% 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
Meritain	$64	47%
Bas	$96	71%
Aetna	$121 - $319	89%
Auxiant	$160	118%
Blue_Cross	$191 - $319	141%
Champva	$191	141%
Health_Partners	$191	141%
Admin_Concepts	$204	150%
UnitedHealthcare	$223 - $319	164%
Va	$239	176%
Champus	$242	178%
Humana	$281 - $319	207%
Healthscope	$287	212%
Midlands_Choice	$300	221%
Cigna	$306	226%

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 $255.
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 Loring 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.