CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Sanford Medical Center Fargo

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $173
Cash Discount Price: $249
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Sanford Medical Center Fargo is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $249. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.28x the Medicare baseline. Located in 801 Broadway North, Fargo, ND.

Cash / Self-Pay

$249

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

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: $249 (184%)

Insurance Median: $173 (128%)

Cash: $249 (184% of Medicare)

Ins. Median: $173 (128% 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
Sanford Health Plan	$86 - $116	63%
Sanford Health Plan Align	$116	86%
Ucare	$125 - $219	92%
Aetna	$126 - $266	93%
Blue Cross Blue Shield	$126 - $173	93%
Health Partners	$126 - $128	93%
Medicare (plans)	$126	93%
UnitedHealthcare	$126 - $271	93%
Primewest	$128	94%
Medica	$140 - $150	103%
Security Health Plan	$171	126%
Cigna	$280	206%
First Choice Health Network	$280	206%
Healthez	$280	206%
Multiplan	$280	206%

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 $249.
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 Sanford Medical Center Fargo 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.