CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adventist Health Portland

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $247
  • Cash Discount Price: $132
  • vs. Medicare Baseline: 1.82x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adventist Health Portland is $247. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.82x the Medicare baseline. Located in 10123 Se Market Street, Portland, OR.
Cash / Self-Pay
$132

Average discount available for prompt cash payment at this facility.

Insurance Median
$247

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: $132 (97%)
Insurance Median: $247 (182%)
Cash: $132 (97% of Medicare)
Ins. Median: $247 (182% 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.

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
Ods - All Plans $69 51%
Care Oregon - All Plans $73 54%
Kaiser Mcr Adv $86 63%
Humana $88 - $91 65%
Moda Mcr Adv $91 67%
UnitedHealthcare $91 - $247 67%
Healthcare Resources - All Plans $92 68%
Healthnet Mcr Adv $99 73%
Workers Comp $142 105%
Ah Employee Health Plan - All Plans $155 114%
Moda Conn Oebb/Syn Pebb $172 127%
Moda Affinity - All Other Plans $198 146%
Bc Premera First - All Plans $206 152%
Kaiser - All Other Plans $224 165%
Healthnet Hmo/Pos - All Other Plans $234 173%
Healthnet Epo/Pos/Ppo $236 174%
Worldventure - All Plans $247 182%
Pacific Source Comm - All Plans $259 191%
Providence Hp - All Plans $267 197%
Regence Preferred Mcr Adv $268 198%
Moda Select $269 198%
Regence - All Other Plans $269 198%
Cigna $277 204%
First Choice - All Plans $285 210%
Moda Connexus $305 225%
Multiplan - All Plans $308 227%
Phcs - All Plans $308 227%
Regence Mcr Adv $312 230%
Aetna $321 237%
Moda Synergy $322 237%
First Health-Coventry - All Plans $329 243%
National Provider Network - All Plans $362 267%
Health Payors Organization Ltd- All Plans $370 273%
Moda Ohsu Ppo/Epo/Hmc $740 546%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 10123 Se Market Street, Portland, OR 97216
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals