CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $158
Cash Discount Price: $246
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Saint Alphonsus Medical Center Ontario is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $246. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.17x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.

Cash / Self-Pay

$246

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $246 (181%)

Insurance Median: $158 (117%)

Cash: $246 (181% of Medicare)

Ins. Median: $158 (117% 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
Medicaid / KanCare	$66 - $108	49%
UnitedHealthcare	$85 - $208	63%
Humana	$97 - $157	72%
Oregon Screenwise	$102	75%
Pacificsource Health Plans	$122 - $212	90%
Moda Health	$129 - $226	95%
Aetna	$147 - $190	108%
Allied Benefit Systems	$147 - $190	108%
Asr Health Benefits	$147 - $190	108%
Boon Chapman	$147 - $190	108%
Christian Brother Services	$147 - $190	108%
Geha	$147 - $208	108%
Healthscope	$147 - $190	108%
Luminare Health (Detroit)	$147 - $190	108%
Meritain	$147 - $190	108%
Rural Carrier Health Benefit Plan	$147 - $190	108%
Asuris Northwest Health	$158 - $208	117%
Blue Shield - Id (Regence)	$158 - $208	117%
Healthcare Management Admin	$158 - $208	117%
Cigna	$169 - $218	125%
Mountain Health Co-Op	$174 - $226	128%
Selecthealth	$174 - $275	128%
St Lukes Health Plan	$194 - $248	143%

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 $246.
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 Saint Alphonsus Medical Center Ontario 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.