CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Piedmont Walton Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $392
Cash Discount Price: $173
vs. Medicare Baseline: 2.89x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Piedmont Walton Hospital is $392. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $173. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.89x the Medicare baseline. Located in 2151 W Spring Street, Monroe, GA.

Cash / Self-Pay

$173

Average discount available for prompt cash payment at this facility.

Insurance Median

$392

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: $173 (128%)

Insurance Median: $392 (289%)

Cash: $173 (128% of Medicare)

Ins. Median: $392 (289% 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 289% of the Medicare baseline (a markup of 189%). 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
Medicaid / KanCare	$52 - $54	38%
UnitedHealthcare	$245 - $377	181%
Cigna	$247 - $346	182%
Alliant Health Plans Of Georgia [10952]	$392	289%
First Health [10303]	$403	297%
Aetna	$410	302%
Novanet [10819]	$432	319%
Multiplan [10600]	$461	340%
Phcs [10601]	$461	340%
Kaiser [10500]	$490	361%
Beechstreet [10800]	$518	382%

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 $173.
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 Piedmont Walton 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.