CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Essentia Health Ada

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $109
Cash Discount Price: $131
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Essentia Health Ada is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.80x the Medicare baseline. Located in 201 9Th Street West, Ada, MN.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $131 (97%)

Insurance Median: $109 (80%)

Cash: $131 (97% of Medicare)

Ins. Median: $109 (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	$59 - $79	44%
Medica Access	$60 - $127	44%
Sanford Health Plan	$65 - $92	48%
Advocare/Security Health	$72 - $98	53%
Blue Cross Blue Shield	$72 - $178	53%
Freedom Blue Ppo	$72 - $98	53%
Healthpartners Care Msho / Mcr Adv	$72 - $98	53%
Imcare Msho Pcc Prime	$72 - $98	53%
Imcare Msho Ref Req	$72 - $98	53%
Medica Advantage Solutions	$72 - $98	53%
Medica Msho/Dual Solutions	$72 - $98	53%
Medica Prime Solution Group	$72 - $98	53%
Medicare (plans)	$72 - $98	53%
Nd Va Administration	$72 - $98	53%
Platinum Blue/Vantage Blue	$72 - $98	53%
Primewest Msho	$72 - $98	53%
Secure Blue Msho	$72 - $98	53%
Ubh Cost Plan	$72 - $98	53%
Ubh Msho	$72 - $98	53%
Ucare Msho	$72 - $98	53%
UnitedHealthcare	$72 - $185	53%
Blue Plus Pmap Pcc Prime	$83 - $178	61%
Healthpartners	$92 - $136	68%
Ucare	$99 - $134	73%
Cigna	$100 - $136	74%
Healthpartners Pcc Prime	$100 - $136	74%
Wea	$109 - $157	80%
America'S Ppo	$117 - $158	86%
Medica	$125 - $178	92%
Medica Uplan	$125 - $170	92%
Wps	$125 - $171	92%
Aetna	$128 - $173	94%
Medica Choice	$136 - $184	100%

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 $131.
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 Ada 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.