Office visit, established patient (30-39 min)
Facility: Pratt Regional Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $192
- Cash Discount Price: $150
- vs. Medicare Baseline: 1.42x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Christian Health Aid | $100 - $197 | 74% |
| UnitedHealthcare | $111 - $268 | 82% |
| Health Partners Of Kansas | $113 - $224 | 83% |
| Aetna | $120 - $237 | 88% |
| Choicecare | $133 - $263 | 98% |
Consumer Guidance & Cost Commentary
For this office visit at Pratt Regional Medical Center in Pratt, KS, the cash price of $150 is notably lower than the facility's negotiated rates, which range from $100 to $268 depending on the insurance carrier. While the facility's negotiated average of $192 is higher than the cash price, patients with high-deductible plans may find paying cash upfront more cost-effective, as the cash rate avoids the administrative overhead and potential balance billing associated with insurance claims. It is important to note that the facility is an acute care hospital with a proprietary ownership structure, and while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details before scheduling to ensure they are not subject to unexpected charges.
When evaluating the value of this service, it is helpful to compare the pricing against federal benchmarks rather than the hospital's full list price. The Medicare amount for this code is $135.60, and the facility's cash rate of $150 represents a markup of 1.4 times the Medicare rate, which falls within the range of fair pricing typically defined as 120% to 150% of Medicare. Although the data does not provide specific state or county average comparisons for this code, patients should be aware that commercial negotiated rates often include significant administrative costs that inflate the baseline price by 20% to 40%. To maximize savings, consumers should request a prompt-pay discount before check-in, which can reduce the bill by 20% to 50% if paid in full within 30 days, and always demand an itemized bill to review every charge for