CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Witham Health Services

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $453
Cash Discount Price: $341
vs. Medicare Baseline: 3.34x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Witham Health Services is $453. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $341. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.34x the Medicare baseline. Located in 2605 N Lebanon St, Lebanon, IN.

Cash / Self-Pay

$341

Average discount available for prompt cash payment at this facility.

Insurance Median

$453

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: $341 (251%)

Insurance Median: $453 (334%)

Cash: $341 (251% of Medicare)

Ins. Median: $453 (334% 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 334% of the Medicare baseline (a markup of 234%). 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
Aetna	$70 - $514	52%
Blue Cross Blue Shield	$81 - $694	60%
Mdwise Health In-All Plans	$81 - $89	60%
UnitedHealthcare	$81 - $541	60%
Encore-All Plans	$82 - $659	60%
Caresource Mcr Adv	$83	61%
Caresource Indiana Marketplace-All Other Plans	$109 - $154	80%
Sagamore-All Plans	$109 - $639	80%
Beech Street-All Plans	$117 - $652	86%
Phcs/Multiplan-All Plans	$154 - $632	114%
Humana	$157 - $645	116%
Mhs Comml Exch-All Plans	$202 - $1,735	149%

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 $341.
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 Witham Health Services 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.