CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Essentia Health St Marys - Detroit Lakes

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $108
Cash Discount Price: $94
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Essentia Health St Marys - Detroit Lakes is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.80x the Medicare baseline. Located in 1027 Washington Ave, Detroit Lakes, MN.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $94 (69%)

Insurance Median: $108 (80%)

Cash: $94 (69% of Medicare)

Ins. Median: $108 (80% 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
Healthpartners Care Pmap	$57	42%
Sanford Healthplan	$63 - $66	46%
Blue Cross Blue Shield	$66 - $173	49%
Medica Uplan	$93	69%
Ucare	$97	72%
Healthpartners	$99 - $108	73%
Medica	$103 - $114	76%
Wea	$106 - $113	78%
Cigna	$108	80%
Healthpartners Pcc Prime	$108	80%
America'S Ppo	$114	84%
Medica Choice	$117	86%
Wps	$122 - $123	90%
UnitedHealthcare	$123	91%
Aetna	$125	92%
Healtheos	$126	93%

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 $94.
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 Essentia Health St Marys - Detroit Lakes 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.