CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Elkhart General Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $87
Cash Discount Price: $83
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Elkhart General Hospital is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.64x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $83 (61%)

Insurance Median: $87 (64%)

Cash: $83 (61% of Medicare)

Ins. Median: $87 (64% 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
Aetna	$24 - $203	18%
Devoted Healthcare	$25 - $60	18%
Blue Cross Blue Shield	$27 - $74	20%
Cha	$32 - $234	24%
Immergrun	$32 - $240	24%
Mhs	$35 - $390	26%
Php	$35 - $210	26%
UnitedHealthcare	$36 - $202	27%
Humana	$37 - $210	27%
Cigna	$39 - $228	29%
Multiplan	$39 - $216	29%
Signature	$39 - $219	29%
Encore	$40 - $222	29%
Plain Church	$43 - $240	32%
Heartland	$54 - $300	40%
Caresource	$70 - $390	52%
Mdwise	$70 - $390	52%

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 $83.
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 Elkhart General 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.