CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 99214 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$149

about 1.1× the $136 Medicare rate · typically $75–$236

modeled estimate · not a bill or quote

What this hospital charges insurers

$171

About the fair price

about $22 over the fair price · 1.3× Medicare

Medicare pays $136 Fair price $149 This hospital $171 Cash price $246 Hospital's list price $246

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

Highest price of the 9 OR hospitals we have prices for — worth calling around.

Cheapest $51 Priciest $171

Black dot = this hospital, among the 9 OR hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (30-39 min) is about $149 (about 1.1× the $136 Medicare rate). Saint Alphonsus Medical Center Ontario charges insurers about $171, or about $246 in cash — about the fair price. Located in Ontario, OR.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$85 - $208	63%
Blue Cross Blue Shieldmajor	$158 - $208	117%
Aetnamajor	$147 - $190	108%
Cignamajor	$169 - $218	125%
Humanamajor	$97 - $157	72%
GEHA	$147 - $208	108%
Moda Health	$129 - $226	95%
PacificSource	$122 - $212	90%
SelectHealth	$174 - $275	128%
+ 12 smaller / regional plans	$102 - $248

Government programs also on file: Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 246), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99214.

Insurance Before you use insurance

Call your insurance company to confirm Saint Alphonsus Medical Center Ontario is in-network.
Ask your insurer whether prior approval is required for CPT code 99214.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Saint Alphonsus Medical Center Ontario

Compare: Office visit, established patient (30-39 min) at other OR hospitals

Insurance negotiated median for the same procedure, sorted lowest first.