CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Woodlawn Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $95
Cash Discount Price: $240
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Woodlawn Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $240. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.70x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$240

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $240 (177%)

Insurance Median: $95 (70%)

Cash: $240 (177% of Medicare)

Ins. Median: $95 (70% 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	$71 - $305	52%
Blue Cross Blue Shield	$71 - $321	52%
Caresource Mcaid Hip	$71	52%
Caresource Mcr Adv	$71	52%
Humana	$71 - $249	52%
Mdwise Mcaid Excel Hip	$71 - $81	52%
Mhs Exch Mrktplce-All Other Plans	$71 - $81	52%
Mhs Mcaid Hip	$71 - $81	52%
UnitedHealthcare	$71 - $321	52%
Mhs Mcr Adv	$72	53%
Mdwise Excel Hhw & Hcc	$77	57%
Mhs Mcaid Hcc	$77 - $321	57%
Mhs Mcaid Hhw	$77 - $321	57%
Phcs/Multiplan-All Plans	$81 - $299	60%
Caresource Mcaid Hww	$89 - $321	66%
Caresource Exch - All Other Plans	$92 - $101	68%
Ambetter / Centene	$94 - $108	69%
Encore Comm-All Plans	$97 - $273	72%
Partners Direct Health-All Plans	$97 - $218	72%
Cigna	$230 - $273	170%
Parkview Health Plans-All Plans	$238 - $241	176%
Sagamore All Other Grps - All Other Plans	$270	199%
Community Health Alliance-All Plans	$305	225%

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 $240.
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 Woodlawn 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.