CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Franciscan Health Mooresville

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $191
Cash Discount Price: $71
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Franciscan Health Mooresville is $191. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.41x the Medicare baseline. Located in 1201 Hadley Rd, Mooresville, IN.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$191

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: $71 (52%)

Insurance Median: $191 (141%)

Cash: $71 (52% of Medicare)

Ins. Median: $191 (141% 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
Blue Cross Blue Shield	$81 - $162	60%
Medicare (plans)	$81 - $155	60%
Commercial [2001]	$106 - $484	78%
Managed Care [2000]	$106 - $460	78%
Aetna	$108 - $333	80%
UnitedHealthcare	$157 - $293	116%
Mdwise [1175]	$159	117%
Medicaid / KanCare	$159 - $191	117%
United Medical Resources [1158]	$160 - $293	118%
United Medical Resources [1301]	$160 - $293	118%
Unicare [1150]	$162	119%
Workers Comp [1172]	$162 - $282	119%
Managed Health Services [1302]	$164	121%
Cigna	$168 - $308	124%
Great West Insurance [1055]	$172 - $315	127%
Humana	$184 - $337	136%

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 $71.
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 Franciscan Health Mooresville 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.