CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Brookings Health System

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $173
Cash Discount Price: $158
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Brookings Health System is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.28x the Medicare baseline. Located in 300 22Nd Ave, Brookings, SD.

Cash / Self-Pay

$158

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: $158 (117%)

Insurance Median: $173 (128%)

Cash: $158 (117% 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
Medicaid / KanCare	$88 - $369	65%
Medicare (plans)	$95 - $369	70%
Sanford_Bhcag	$117 - $351	86%
Medica_Msho	$145 - $165	107%
Medica_Choice_Care	$148 - $165	109%
Blue Cross Blue Shield	$151 - $369	111%
Avera	$156 - $332	115%
Medica	$165 - $270	122%
Medica_Accessibility_Solution	$165 - $270	122%
Medica_Selectcare	$165 - $270	122%
UnitedHealthcare	$181 - $306	133%
Multiplan	$211 - $358	156%
Humana	$332	245%

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 $158.
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 Brookings Health System 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.