CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Valor Health

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $159
Cash Discount Price: $262
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Valor Health is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $262. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.17x the Medicare baseline. Located in 1202 East Locust Street, Emmett, ID.

Cash / Self-Pay

$262

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $262 (193%)

Insurance Median: $159 (117%)

Cash: $262 (193% of Medicare)

Ins. Median: $159 (117% 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
Tricare	$32 - $223	24%
Aetna	$33 - $244	24%
Blue Cross Blue Shield	$33 - $448	24%
Blue Shield Mcr Adv	$33 - $230	24%
Humana	$33 - $287	24%
Molina Mcr Adv - All Plans	$33 - $230	24%
Regence Bs Triwest - All Plans	$33 - $230	24%
UnitedHealthcare	$33 - $270	24%
Pacificsource Mcr Adv	$35 - $241	26%
Moda Health - All Plans	$66 - $278	49%
Pacificsource Comm - All Other Plans	$66 - $278	49%
Select Health Comm - All Other Plans	$66 - $278	49%
Select Health Mcr Adv	$90 - $208	66%
Blue Shield Comm - All Other Plans	$144	106%
Cigna	$160 - $270	118%

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 $262.
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 Valor Health 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.