CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Incline Village Community Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $144
Cash Discount Price: $190
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Incline Village Community Hospital is $144. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $190. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.06x the Medicare baseline. Located in 880 Alder Street, Incline Village, NV.

Cash / Self-Pay

$190

Average discount available for prompt cash payment at this facility.

Insurance Median

$144

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: $190 (140%)

Insurance Median: $144 (106%)

Cash: $190 (140% of Medicare)

Ins. Median: $144 (106% 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	$42 - $336	31%
Medicare (plans)	$58 - $145	43%
UnitedHealthcare	$108 - $140	80%
Ca Hlth And Wellness - All Plans	$113 - $380	83%
Healthnet - All Plans	$113 - $354	83%
Aetna	$131 - $328	97%
Prominence Healthfirst - All Plans	$131 - $328	97%
Admar Multiplan - All Plans	$134 - $202	99%
First Health - All Plans	$134 - $336	99%
Great West/One Health - All Plans	$134 - $336	99%
Hometown Hp - All Plans	$134 - $317	99%
Humana	$134 - $336	99%
Interplan - All Plans	$134 - $202	99%
Multiplan - All Plans	$134 - $202	99%
Phcs - All Plans	$134 - $202	99%
Cigna	$137 - $343	101%
Beech Street/Capp Care - All Plans	$142 - $354	105%
Uhn - All Plans	$142 - $336	105%
Sierra Health - All Plans	$145 - $362	107%

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 $190.
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 Incline Village Community Hospital 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.