CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Saint Joseph Regional Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $100
  • Cash Discount Price: $274
  • vs. Medicare Baseline: 0.74x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Saint Joseph Regional Medical Center is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $274. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.74x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$274

Average discount available for prompt cash payment at this facility.

Insurance Median
$100

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: $274 (202%)
Insurance Median: $100 (74%)
Cash: $274 (202% of Medicare)
Ins. Median: $100 (74% 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.

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 $14 - $168 10%
Albany County Correctional Facility $14 - $118 10%
Ambetter / Centene $14 - $118 10%
Amish Mennonite $14 - $118 10%
Ascension St. Vincent Public Safety Medical $14 - $118 10%
Bcccp-Michigan $14 - $118 10%
Bccp $14 - $118 10%
Blue Cross Blue Shield $14 - $891 10%
Bmc Healthnet $14 - $118 10%
Breast Grant-Connecticut $14 - $118 10%
Broward County Dept Of Health $14 - $118 10%
California Health And Wellness $14 - $118 10%
Cardinal Innovations Lme $14 - $118 10%
Care Connections Of Northern Iowa $14 - $118 10%
Care Oregon Ohp $14 - $118 10%
Cencal Health Plan $14 - $118 10%
Cenpatico $14 - $118 10%
Champva $14 - $118 10%
Chhuny $14 - $118 10%
Childrens Comm Health Plan $14 - $118 10%
Childrens Medical Services Title 19 $14 - $118 10%
Cigna $14 - $189 10%
City Of Philadelphia $14 - $118 10%
Cmh Allegan County $14 - $118 10%
Cmh Ausable Valley $14 - $118 10%
Cmh Barry County $14 - $118 10%
Cmh Bay-Arenac County $14 - $118 10%
Cmh Berrien County $14 - $118 10%
Cmh Cass County $14 - $118 10%
Cmh Central Mi County $14 - $118 10%
Cmh Clinton-Eaton-Ingham County $14 - $118 10%
Cmh Detroit Wayne Integrated Health Network $14 - $118 10%
Cmh Genesee County $14 - $118 10%
Cmh Ionia County $14 - $118 10%
Cmh Jackson County/Lifeways $14 - $118 10%
Cmh Kalamazoo $14 - $118 10%
Cmh Kent County $14 - $118 10%
Cmh Lenawee County $14 - $118 10%
Cmh Livingston County $14 - $118 10%
Cmh Macomb $14 - $118 10%
Cmh Misc $14 - $118 10%
Cmh Monroe County $14 - $118 10%
Cmh Montcalm County $14 - $118 10%
Cmh Muskegon County $14 - $118 10%
Cmh Newaygo County $14 - $118 10%
Cmh North Country $14 - $118 10%
Cmh Northern Lakes County $14 - $118 10%
Cmh Oakland County $14 - $118 10%
Cmh Ottawa County $14 - $118 10%
Cmh Van Buren County $14 - $118 10%
Cmh Washtenaw County $14 - $118 10%
Cmh Wayne County/Carelink $14 - $118 10%
Cmh Wayne Cty/Com Liv Svcs $14 - $118 10%
Cmh West Mi County $14 - $118 10%
Community Benefit Health $14 - $118 10%
Community Care Behavorial Health $14 - $118 10%
Community Care Partners $14 - $118 10%
Community Health Choice $14 - $118 10%
Connections Csp $14 - $118 10%
County Coroner $14 - $118 10%
County Funding Generic $14 - $118 10%
Covid19 Hrsa Uninsured Testing And Treatment Fund $14 - $118 10%
Dean Wi Badgercare $14 - $118 10%
Delaware County Department Of Health $14 - $118 10%
Delaware First Health $14 - $118 10%
Delta Dental Nj $14 - $118 10%
Dph Tb Program $14 - $118 10%
Dscc $14 - $118 10%
Eastpointe Lme $14 - $118 10%
Family Health Network $14 - $118 10%
Freedom First Healthcare $14 - $118 10%
Fresno County Ccs $14 - $118 10%
Ghc Scw Wi Badgercare $14 - $118 10%
Harbor Health $14 - $118 10%
Health Safety Net $14 - $118 10%
Healthy Blue Ne $14 - $118 10%
Hennepin Health $14 - $118 10%
Humana $14 - $126 10%
Id County Ada $14 - $118 10%
Id County Canyon $14 - $118 10%
Id County Cat Fund $14 - $118 10%
Id County Other $14 - $118 10%
Id County Payette $14 - $118 10%
Idaho Dept Health And Wellfare $14 - $118 10%
Idaho Womens Health Check $14 - $118 10%
Indiana Breast Cervical Cancer $14 - $118 10%
Inland Empire Health Plan $14 - $118 10%
Intercommunity Health Ohp $14 - $118 10%
Iowa Total Care $14 - $118 10%
Jai Medical System $14 - $118 10%
Kern Family Health Plan $14 - $118 10%
Keystone First $14 - $118 10%
Keystone First Chip $14 - $118 10%
La Care Health Plan $14 - $118 10%
Lakeland Care Inc $14 - $118 10%
Managed Health Services - Indiana $14 - $159 10%
Maryland Breast & Cervical Program $14 - $118 10%
Maryland Healthy Smiles - Scion Dental $14 - $118 10%
Maryland Physicians Care $14 - $118 10%
Massachusetts Behavioral Health Partnership $14 - $118 10%
Mdwise $14 - $159 10%
Medi-Cal $14 - $118 10%
Medi-Cal Healthnet $14 - $118 10%
Medicaid / KanCare $14 - $159 10%
Medstar Dc Healthy Family $14 - $118 10%
Medstar Md Health Choice $14 - $118 10%
Mo Home State Health Plan $14 - $118 10%
Molina Centennial Care $14 - $118 10%
Nascentia Health Options $14 - $118 10%
Nebraska Total Care $14 - $118 10%
New York Cancer Services Program $14 - $118 10%
Nextlevel Health $14 - $118 10%
Oregon Screenwise $14 - $118 10%
Pace Of Southwest Michigan $14 - $126 10%
Paramount Advantage $14 - $118 10%
Parkland Community Health Plan $14 - $118 10%
Partners Behavioral Lme $14 - $118 10%
Peach State Healthplan $14 - $118 10%
Philadelphia County Funding $14 - $118 10%
Presbyterian Centennial Care $14 - $118 10%
Prestige Health Choice $14 - $118 10%
Priority Partners $14 - $118 10%
Provider Partners Health Plan Of Indiana $14 - $141 10%
Robert F Sing Program $14 - $118 10%
Rx 340B Pass Along $14 - $118 10%
Rx Assistance/Rx Manufacturer Assistance 0 Copay $14 - $118 10%
Rx Medi-Cal $14 - $118 10%
Rx Meridian Rx $14 - $118 10%
Ryan White Florida Mssrp $14 - $118 10%
Sandhills Center Lme $14 - $118 10%
Screening For Life $14 - $118 10%
St Joseph County Hlth Dpt $14 - $121 10%
Stephenson Cty Health $14 - $118 10%
Sunshine State Health Plan $14 - $118 10%
Superior Health $14 - $118 10%
Tenncare $14 - $118 10%
Texas Children'S Health Plan $14 - $118 10%
Tricare $14 - $118 10%
Trillium Community Ohp $14 - $118 10%
Triwest Health Alliance $14 - $118 10%
Tufts Health Public Plans $14 - $118 10%
UnitedHealthcare $14 - $159 10%
Us Family Health Plan $14 - $118 10%
Vaya Health Lme $14 - $118 10%
Veterans Eval Services $14 - $118 10%
Washtenaw Health Plan $14 - $118 10%
Wellsense Health Plan $14 - $118 10%
Wi Womens Wellness $14 - $118 10%
Andrie Inc $16 - $128 12%
East Greenbush Central School District $16 - $128 12%
Genex Wc $16 - $128 12%
Healthsmart Workers Comp $16 - $128 12%
Jag Source $16 - $128 12%
New York State Insurance Fund $16 - $128 12%
Njm Insurance Group $16 - $128 12%
Rx Heatlhcomp $16 - $128 12%
Rx Restat $16 - $128 12%
Rx Saif Opdp Wc $16 - $128 12%
Rx Worker'S Comp $16 - $128 12%
Wc Accident Fund $16 - $128 12%
Wc Ace $16 - $128 12%
Wc Acs Federal Employees $16 - $128 12%
Wc Acuity $16 - $128 12%
Wc Advantage $16 - $128 12%
Wc Aegis $16 - $128 12%
Wc Aig $16 - $128 12%
Wc Aims $16 - $128 12%
Wc Alaska National Ins $16 - $128 12%
Wc Align Network $16 - $128 12%
Wc Allied $16 - $128 12%
Wc Am Trust N America $16 - $128 12%
Wc American Claims Mgmt $16 - $128 12%
Wc Amerisure $16 - $128 12%
Wc Amtrust $16 - $128 12%
Wc Asu Risk Mgt $16 - $128 12%
Wc Benetech $16 - $128 12%
Wc Berkley Admin $16 - $128 12%
Wc Broadspire $16 - $128 12%
Wc Broward County $16 - $128 12%
Wc Bunch & Associates $16 - $128 12%
Wc California State Comp Ins $16 - $128 12%
Wc California State Ins Fund $16 - $128 12%
Wc Capitol Area Health Consortium $16 - $128 12%
Wc Ccmsi $16 - $128 12%
Wc Chartis $16 - $128 12%
Wc Chubb $16 - $128 12%
Wc Cirma $16 - $128 12%
Wc City Of Albany $16 - $128 12%
Wc City Of Sioux City $16 - $128 12%
Wc Claims Mgmt Inc $16 - $128 12%
Wc Cna $16 - $128 12%
Wc Comp One Admin C/O Manageability $16 - $128 12%
Wc Compone Admin $16 - $128 12%
Wc Corvel $16 - $128 12%
Wc Ct Healthcare Trust $16 - $128 12%
Wc Donegal Insurance Group $16 - $128 12%
Wc Emc Insurance Company $16 - $128 12%
Wc Employee Mutual $16 - $128 12%
Wc Enablecomp $16 - $128 12%
Wc Erie $16 - $128 12%
Wc Esis $16 - $128 12%
Wc Evolutions $16 - $128 12%
Wc Fcci $16 - $128 12%
Wc Fed Ex $16 - $128 12%
Wc Federal Black Lung $16 - $128 12%
Wc Federated $16 - $128 12%
Wc Finley Occupational Health $16 - $128 12%
Wc First Agency/Occunet $16 - $128 12%
Wc Ford Motor $16 - $128 12%
Wc Fresno Unified Emp $16 - $128 12%
Wc Gallagher Bassett $16 - $128 12%
Wc General Motors $16 - $128 12%
Wc Generic $16 - $128 12%
Wc Genex Care For Ohio $16 - $128 12%
Wc Great West Casualty $16 - $128 12%
Wc Guarantee Insurance $16 - $128 12%
Wc Guard Insurance Company $16 - $128 12%
Wc Hab $16 - $128 12%
Wc Hartford $16 - $128 12%
Wc Hastings $16 - $128 12%
Wc Health Management $16 - $128 12%
Wc Heritage Summit $16 - $128 12%
Wc Hireright $16 - $128 12%
Wc Horizon $16 - $128 12%
Wc Icw Group $16 - $128 12%
Wc Idaho State Ins Fund $16 - $128 12%
Wc Intercare Insurance $16 - $128 12%
Wc Intermountain $16 - $128 12%
Wc Johns Eastern $16 - $128 12%
Wc Kemberton $16 - $128 12%
Wc Key Ins & Benefit Solutions $16 - $128 12%
Wc Liberty Mutual $16 - $128 12%
Wc Mac Risk Management $16 - $128 12%
Wc Massachusetts $16 - $128 12%
Wc Mdia $16 - $128 12%
Wc Meadowbrook Claim $16 - $128 12%
Wc Medical Administrators $16 - $128 12%
Wc Meijers $16 - $128 12%
Wc Memic $16 - $128 12%
Wc Mercy Workcare $16 - $128 12%
Wc Michigan $16 - $128 12%
Wc Michigan Millers Mutual $16 - $128 12%
Wc Mitchell Frankenmuth $16 - $128 12%
Wc Mra $16 - $128 12%
Wc Nationwide $16 - $128 12%
Wc Nca Comp $16 - $128 12%
Wc New York $16 - $128 12%
Wc New York Special Funds $16 - $128 12%
Wc North American Rishces $16 - $128 12%
Wc Northeast Health $16 - $128 12%
Wc Notre Dame $16 - $128 12%
Wc Novanet $16 - $128 12%
Wc O'Hara Corp $16 - $128 12%
Wc Occ Health Allen $16 - $128 12%
Wc Ohio Bureau $16 - $128 12%
Wc One Call Medical $16 - $128 12%
Wc Paradigm $16 - $128 12%
Wc Peerless $16 - $128 12%
Wc Pma $16 - $128 12%
Wc Praxis Health Network $16 - $128 12%
Wc Price Chopper $16 - $128 12%
Wc Procura Management $16 - $128 12%
Wc Qualcare $16 - $128 12%
Wc Quiktrip $16 - $128 12%
Wc Reny Company $16 - $128 12%
Wc Rev Claims $16 - $128 12%
Wc Risico $16 - $128 12%
Wc Rural Mutual $16 - $128 12%
Wc Saif Oregon $16 - $128 12%
Wc Secura $16 - $128 12%
Wc Sedgwick $16 - $128 12%
Wc Sentry $16 - $128 12%
Wc Sheakley Unicomp $16 - $128 12%
Wc Smile Lodge $16 - $128 12%
Wc Society $16 - $128 12%
Wc Srs $16 - $128 12%
Wc Taconic (Mro) $16 - $128 12%
Wc Taconic Farms $16 - $128 12%
Wc Travelers $16 - $128 12%
Wc Triad Group $16 - $128 12%
Wc Tristar $16 - $128 12%
Wc Troy Ny $16 - $128 12%
Wc Tyson $16 - $128 12%
Wc Unified Health Services $16 - $128 12%
Wc United Heartland $16 - $128 12%
Wc Us Dept Of Labor $16 - $128 12%
Wc Velocity $16 - $128 12%
Wc Walmart $16 - $128 12%
Wc West Bend $16 - $128 12%
Wc West Bend Mutual/Argent $16 - $128 12%
Wc Winnebago Industries $16 - $128 12%
Wc Yankee Trails $16 - $128 12%
Wc York Risk $16 - $128 12%
Wc Zenith $16 - $128 12%
Wc Zurich $16 - $128 12%
Caresource $17 - $391 13%
Christian Brother Services $17 - $168 13%
Meritain $17 - $168 13%
Preferred One $17 - $168 13%
Ameriben $19 - $169 14%
Geha $19 - $158 14%
Align Senior Care $20 - $126 15%
Ally Align Care Adv $20 - $126 15%
American Health Advantage Of Idaho $20 - $126 15%
American Health Plan $20 - $126 15%
Aurora Special Needs $20 - $126 15%
Bcn Domestic $20 - $142 15%
Blue Benefit Administrators Of Massachusetts $20 - $891 15%
Blue Care Network $20 - $891 15%
Blue Care Network Advantage $20 - $126 15%
Blue Distinction Transplant $20 - $891 15%
Blue Shield - Ca $20 - $891 15%
Blue Shield - De (Highmark) Medciare Advantage $20 - $126 15%
Blue Shield - Id (Regence) $20 - $891 15%
Blue Shield - Ny Highmark Northeastern $20 - $891 15%
Blue Shield - Ny Highmark Western $20 - $891 15%
Blue Shield - Pa (Highmark) $20 - $891 15%
Blue Shield - Wa (Regence) $20 - $891 15%
Care Dimensions $20 - $126 15%
Care Improvement Plus $20 - $126 15%
Care Resources Pace $20 - $126 15%
Careplus Health Plans $20 - $126 15%
Cca - Zing Health $20 - $126 15%
Cca Senior Care Options $20 - $126 15%
Central Valley Medical Services Corp Pace $20 - $126 15%
Champion Health Plan Mcr Advantage $20 - $126 15%
Clear Spring Health $20 - $126 15%
Clover Health $20 - $126 15%
Commonwealth Care Alliance $20 - $126 15%
Community Health Alliance $20 - $138 15%
Community Pace At Home $20 - $126 15%
Eddy Senior Care-Pace $20 - $126 15%
Eddy Seniorcare Pace $20 - $126 15%
Elementcare $20 - $126 15%
Evercare $20 - $126 15%
Everence $20 - $126 15%
Gateway Health Plan $20 - $126 15%
Genesys Pace Of Genesee County $20 - $126 15%
Georgia Health Advantage $20 - $126 15%
Gold Advantage $20 - $126 15%
Gpa Croell Redi Mix $20 - $126 15%
Health America Advantra $20 - $126 15%
Health Choices $20 - $142 15%
Highmark Health Options Dual Plan $20 - $126 15%
Hope Select Pace $20 - $126 15%
Horizon Nj Total Care $20 - $126 15%
Hudson Headwaters Pace $20 - $126 15%
Huron Valley Pace $20 - $126 15%
Innovative Integrated Health Community Plans $20 - $126 15%
Iowa Health Advantage $20 - $126 15%
Johns Hopkins Advantage Md $20 - $126 15%
Kaiser Domestic $20 - $142 15%
Lasso Healthcare Msa $20 - $126 15%
Life St Marys Pace $20 - $126 15%
Lifecircles Pace $20 - $126 15%
Longevity Health Plan $20 - $126 15%
Longevity Ipa Of Michigan Llc Health Plan Isnp $20 - $126 15%
Martins Point Generations Advantage $20 - $126 15%
Mass General Brigham Mcr Adv $20 - $126 15%
Medicare (plans) $20 - $131 15%
Medipak Advantage $20 - $126 15%
Mercy Life $20 - $126 15%
Mercyone Cedar Valley $20 - $126 15%
Meridian Complete $20 - $126 15%
Michigan Complete Health $20 - $126 15%
Nascentia Health Plus $20 - $126 15%
New Centry Health Careplus $20 - $126 15%
Osu Prime Care Advantage $20 - $126 15%
Pace Cny $20 - $126 15%
Pace Iowa Immanuel Pathways $20 - $126 15%
Pace Southeast $20 - $126 15%
Pace-Trinity Health $20 - $126 15%
Peak Pace Solutions $20 - $126 15%
Perennial Advantage $20 - $126 15%
Pre-Employment $20 - $142 15%
Preferred Care Partners $20 - $126 15%
Presbyterian Senior Plan $20 - $126 15%
Provider Partners Health Plan Of Illinois $20 - $126 15%
Pruitthealth Premier $20 - $126 15%
Reliance Community Care Partners Care Resources Pace $20 - $126 15%
Rx Allwin $20 - $126 15%
Rx Grane Grnmedd $20 - $126 15%
Rx Retiree Rx Care $20 - $126 15%
Scan Health Plan Mcr Ipa Meritage Oon $20 - $126 15%
Secure Horizons Ma Pffs $20 - $126 15%
Serenity Pace $20 - $126 15%
Siouxland Pace $20 - $126 15%
Solis Health Plans $20 - $126 15%
Sunnyview-Pace Finance Dept $20 - $126 15%
Texan Plus $20 - $126 15%
The Health Plan $20 - $126 15%
Thome Pace $20 - $126 15%
Todays Options $20 - $126 15%
Tribute Health Plans $20 - $126 15%
Um Health Advantage $20 - $126 15%
Union Health Service $20 - $126 15%
Wc Domestic $20 - $142 15%
Welbe Health $20 - $126 15%
Wellmed $20 - $126 15%
Allied Benefit Systems $21 - $178 15%
Auxiant $21 - $189 15%
Benefit Administrative Systems,Llc $21 - $178 15%
Custom Design Benefits $21 - $178 15%
Encore Health $21 - $189 15%
Key Benefit Administrator $21 - $178 15%
Luminare Health (Detroit) $21 - $178 15%
Physicians Health Plan Northern Indiana Health Insurance $21 - $244 15%
Veterans Administration $21 - $128 15%
Sagamore Health Network $23 - $189 17%
Signature Care $23 - $189 17%
Wc Encore Health Network $28 - $175 21%
Phcs $30 - $253 22%
Plain Church Group $33 - $281 24%
Siho Insurance Services $130 96%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals