CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Marion Communtiy Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $479
Cash Discount Price: $2,712
vs. Medicare Baseline: 3.53x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Marion Communtiy Hospital is $479. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,712. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.53x the Medicare baseline. Located in 1431 Sw 1St Ave, Ocala, FL.

Cash / Self-Pay

$2,712

Average discount available for prompt cash payment at this facility.

Insurance Median

$479

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: $2,712 (2000%)

Insurance Median: $479 (353%)

Cash: $2,712 (2000% of Medicare)

Ins. Median: $479 (353% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 353% of the Medicare baseline (a markup of 253%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Corvel Corporation	$85 - $169	63%
Prime Health	$86 - $173	63%
Careworks (Rockport Community)	$89 - $178	66%
Marion County Schools	$89 - $178	66%
Aetna	$160 - $813	118%
Blue Cross Blue Shield	$171 - $683	126%
Simply	$418	308%
Cigna	$472 - $1,128	348%
United	$472 - $1,220	348%
Molina Healthcare	$515 - $868	380%
Humana	$542	400%
Sunshine State Health Plan	$691	510%
Plotkin Health	$1,356	1000%
Prime Health Sheriff	$1,356	1000%
Wellpath	$1,627	1200%
Multiplan	$2,115	1560%
Ppo Next	$2,305	1700%
Novanet	$2,440	1799%
American Health Plan	$15,000	11062%

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 $2,712.
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 Marion Communtiy Hospital 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.