CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Nell J Redfield Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $63
Cash Discount Price: $117
vs. Medicare Baseline: 0.46x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Nell J Redfield Memorial Hospital is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.46x the Medicare baseline. Located in 150 North 200 West, Malad City, ID.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $117 (86%)

Insurance Median: $63 (46%)

Cash: $117 (86% of Medicare)

Ins. Median: $63 (46% 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
Aetna	$20 - $114	15%
Bc Mcr Adv	$20 - $132	15%
Choicecare Mcr Adv	$20 - $70	15%
Regence Bs Mcr	$20 - $69	15%
UnitedHealthcare	$20 - $117	15%
Pacificsource Mcr Adv - All Plans	$21 - $71	15%
University Of Ut - All Plans	$32 - $134	24%
Choicecare Ppo - All Other Plans	$34 - $250	25%
Town & Country - All Plans	$34 - $162	25%
Brightpath Select Hlth - All Plans	$36 - $362	27%
Bc Comm - All Other Plans	$39 - $135	29%
Regence Bs Comm - All Other Plans	$141	104%

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 $117.
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 Nell J Redfield Memorial 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.