CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Henry County Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $200
Cash Discount Price: $268
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Henry County Memorial Hospital is $200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $268. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.47x the Medicare baseline. Located in 1000 N 16Th St, New Castle, IN.

Cash / Self-Pay

$268

Average discount available for prompt cash payment at this facility.

Insurance Median

$200

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: $268 (198%)

Insurance Median: $200 (147%)

Cash: $268 (198% of Medicare)

Ins. Median: $200 (147% 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	$70 - $672	52%
UnitedHealthcare	$70 - $644	52%
Cigna	$79 - $538	58%
Blue Cross Blue Shield	$81 - $791	60%
Caresource Hip	$81	60%
Humana	$81 - $696	60%
Caresource Mcr Adv	$83	61%
Caresource Marketplace-All Other Plans	$109 - $154	80%
Caresource Just4Me	$121 - $202	89%
Caresource Mcaid	$122 - $815	90%
Encore Workers Comp-All Plans	$154 - $751	114%
Health Alliance-All Plans	$200 - $672	147%
Workers Comp - All Plans	$212 - $712	156%

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 $268.
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 Henry County Memorial 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.