Office visit, established patient (30-39 min)
Facility: Nmc Health
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $158
- Cash Discount Price: $184
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| Bluestem Pace | $78 | 58% |
| Wppa | $94 - $195 | 69% |
| Occunet | $102 - $212 | 75% |
| Medincrease Health Plan | $111 - $230 | 82% |
| Samaritan Ministries International | $111 - $230 | 82% |
| Leading Age | $125 | 92% |
| Medicaid / KanCare | $125 | 92% |
| Prime Health Services | $128 - $266 | 94% |
| Aetna | $140 - $292 | 103% |
| UnitedHealthcare | $153 - $319 | 113% |
| Cigna | $162 - $336 | 119% |
| Blue Cross Blue Shield | $189 | 139% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the cash median price at Nmc Health in Newton, KS, is $184.00. This cash rate is notably lower than the facility's gross charge of $347.00, which serves as the starting point for insurance negotiations. While the facility's negotiated rates for commercial payers range from $78 to $336 depending on the insurance plan, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $184.00. It is important to note that the median negotiated rate across all payers is $158.00, which is slightly below the cash price, suggesting that for some insurance members, using their plan might result in a lower out-of-pocket cost than paying cash directly.
The facility's pricing structure is evaluated against federal benchmarks, with the Medicare amount for this service set at $135.60. The cash price of $184.00 represents a 1.2x multiplier relative to the Medicare rate, aligning with the typical range where fair pricing is often defined between 120% and 150% of the Medicare baseline. Commercial negotiated rates generally average between 200% and 300% of the Medicare rate, though this specific code shows a lower average due to the inclusion of Medicaid and other public payers. Patients should be aware that hospitals often issue summary bills that obscure individual charges; requesting a full itemized CPT-coded bill is the most effective way to identify errors, unb