CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Sanford Vermillion Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $168
Cash Discount Price: $206
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Sanford Vermillion Medical Center is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $206. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.24x the Medicare baseline. Located in 20 South Plum Street, Vermillion, SD.

Cash / Self-Pay

$206

Average discount available for prompt cash payment at this facility.

Insurance Median

$168

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: $206 (152%)

Insurance Median: $168 (124%)

Cash: $206 (152% of Medicare)

Ins. Median: $168 (124% 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
Sanford Health Plan Align	$59 - $93	44%
Wellmark Sd	$61 - $96	45%
Aetna	$66 - $274	49%
Health Partners	$66 - $236	49%
Medicare (plans)	$66 - $104	49%
Ucare	$66 - $277	49%
UnitedHealthcare	$66 - $263	49%
Primewest	$68 - $106	50%
Sanford Health Plan	$80 - $167	59%
Security Health Plan	$111 - $173	82%
Medica	$166 - $278	122%
Wellmark	$173 - $274	128%
First Choice Health Network	$181 - $284	133%
Healthez	$181 - $284	133%
Multiplan	$181 - $284	133%

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 $206.
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 Sanford Vermillion Medical Center 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.