CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Roundup Memorial Healthcare

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $196
Cash Discount Price: $283
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Roundup Memorial Healthcare is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $283. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.45x the Medicare baseline. Located in 1202 3Rd St W, Roundup, MT.

Cash / Self-Pay

$283

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

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: $283 (209%)

Insurance Median: $196 (145%)

Cash: $283 (209% of Medicare)

Ins. Median: $196 (145% 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
Tricare	$96 - $253	71%
UnitedHealthcare	$96	71%
Va Ccn - All Plans	$96 - $526	71%
Geha-All Plans	$161 - $303	119%
Blue Cross Blue Shield	$176 - $369	130%
Ebms (Rmhn Network) - All Plans	$186 - $351	137%
Pacific Source-All Plans	$186 - $351	137%
First Choice-All Plans	$190 - $358	140%
Montana Health Co-Op Ppo/Pos - All Plans	$190 - $358	140%
Multiplan-All Plans	$190 - $358	140%

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 $283.
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 Roundup Memorial Healthcare 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.