CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Gibson General Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $116
Cash Discount Price: $87
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Gibson General Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.86x the Medicare baseline. Located in 1808 Sherman Drive, Princeton, IN.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $87 (64%)

Insurance Median: $116 (86%)

Cash: $87 (64% of Medicare)

Ins. Median: $116 (86% 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	$66 - $132	49%
Medicaid / KanCare	$66	49%
Meridiancare (Il)	$66	49%
Meridianhealth (Il)	$66	49%
Ky Racing Health & Welfare Fund	$87	64%
Self-Pay	$87	64%
Aetna	$89 - $146	66%
Caresource Just For Me	$89	66%
Medicare (plans)	$89	66%
Meridiancomplete (Il)	$89	66%
Mytruadvantage	$89	66%
UnitedHealthcare	$89 - $119	66%
Va Ccn	$89	66%
Deaconess Onecare	$94	69%
Ambetter / Centene	$98	72%
Chambercare	$105	77%
Alliance Coal	$107	79%
Caresource In Marketplace	$116	86%
Caresource	$119	88%
Mdwise Plans	$119	88%
Mhs	$119	88%
Claimdoc	$125	92%
Hopetrust	$134	99%
Hstechnology	$134	99%
Encircle/Encore Combined	$139	103%
Encircle/Encore Prime	$139	103%
Noncontracted	$143	105%
Cigna	$146	108%
First Health	$146	108%
Healthlink Hmo	$146	108%
Healthlink Ppo	$146	108%
Sagamore (Ppo, Oap-Open Access Plus, Epo, Choice Fund Oap+)	$146	108%
Gibson County Sheriff	$211	156%
Integrated Health	$223	164%
Principal Health Care	$223	164%

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 $87.
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 Gibson 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.