CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Perham Health

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $91
Cash Discount Price: $104
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Perham Health is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.67x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

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: $104 (77%)

Insurance Median: $91 (67%)

Cash: $104 (77% of Medicare)

Ins. Median: $91 (67% 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	$37 - $209	27%
Medica Mcaid Mn Care	$45 - $113	33%
Health Partners Mcr Adv	$46 - $130	34%
Humana	$46 - $105	34%
Medica Mcr Adv	$46 - $105	34%
Medicare (plans)	$46 - $117	34%
Ucare Mn Senior Health Options	$46 - $105	34%
UnitedHealthcare	$47 - $241	35%
Medicaid / KanCare	$48 - $191	35%
Ucare Mn Medical Assistance	$48 - $111	35%
Ucare Mn Minnesota Care	$48 - $111	35%
Ucare Mn Senior Care Plus	$48 - $111	35%
Ucare Mn Special Needs Basic Care	$48 - $111	35%
Ucare Mn Special Needs Basic Care Dual	$48 - $110	35%
Medica Mn (Msho)	$51 - $127	38%
Ucare Individual And Family Plan-All Other Plans	$55 - $128	41%
Medica Mn Senior Hp/Outside Mn	$61 - $94	45%
Health Partners Minnesota Care	$62 - $154	46%
Medica Commercial-All Other Plans	$91 - $226	67%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$100 - $232	74%
Health Partners-All Plans	$102 - $253	75%
Preferred One (Ppo)	$105 - $263	77%
Sanford Health Plan-All Plans	$114 - $263	84%

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 $104.
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 Perham 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.