CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Mary's Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $124
Cash Discount Price: $91
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at St Mary's Hospital is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.91x the Medicare baseline. Located in 701 Lewiston St, Cottonwood, ID.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $91 (67%)

Insurance Median: $124 (91%)

Cash: $91 (67% of Medicare)

Ins. Median: $124 (91% 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
Blue Cross Blue Shield	$76 - $222	56%
Tricare	$81 - $186	60%
Veterans Admin - All Plans	$81 - $186	60%
Aetna	$87 - $211	64%
Medicare (plans)	$87 - $186	64%
Regence Blue Shield Mcr	$87 - $186	64%
UnitedHealthcare	$87 - $186	64%
Nimiipuu Mcr Adv - Allplans	$88 - $188	65%
Idaho Phys Network - All Plans	$101 - $216	74%
Corizon Correctional - All Plans	$102 - $218	75%
Geha - All Plans	$103 - $220	76%
Multiplan - All Plans	$103 - $220	76%
First Choice- All Plans	$104 - $222	77%
Regence Blue Shield - All Other Plans	$106 - $227	78%

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 $91.
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 Mary's 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.