CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Astera Health

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $395
Cash Discount Price: $432
vs. Medicare Baseline: 2.91x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Astera Health is $395. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $432. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.91x the Medicare baseline. Located in 421 11Th Street Nw, Wadena, MN.

Cash / Self-Pay

$432

Average discount available for prompt cash payment at this facility.

Insurance Median

$395

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: $432 (319%)

Insurance Median: $395 (291%)

Cash: $432 (319% of Medicare)

Ins. Median: $395 (291% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 291% of the Medicare baseline (a markup of 191%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Sanford Health Plan [10120]	$42 - $1,071	31%
Blue Plus Pmap [40002]	$51 - $5,128	38%
Ucare Pmap [30006]	$60 - $1,691	44%
Health Partners Pmap [10046]	$71 - $634	52%
Medica Pmap [10057]	$71 - $3,448	52%
Primewest Pmap [30003]	$71 - $3,448	52%
UnitedHealthcare	$85 - $974	63%
Blue Cross Blue Shield	$102 - $5,128	75%
Health Partners [10045]	$102 - $5,128	75%
Medica Nonpmap [10056]	$102 - $98,122	75%
Primewest Non Pmap [30004]	$102 - $5,128	75%
Ucare Non Pmap [30007]	$102 - $5,385	75%
Ucare Commercial [10705]	$194 - $936	143%
Multiplan	$209 - $1,008	154%
Aetna	$235 - $1,134	173%

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 $432.
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 Astera 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.