Office visit, established patient (30-39 min)
Facility: Grisell Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $169
- Cash Discount Price: $211
- vs. Medicare Baseline: 1.25x 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 |
|---|---|---|
| Blue Cross Blue Shield | $76 | 56% |
| UnitedHealthcare | $126 - $179 | 93% |
| Medicaid / KanCare | $169 - $240 | 125% |
| Humana | $316 | 233% |
Consumer Guidance & Cost Commentary
For a 30-39 minute office visit with an established patient at Grisell Memorial Hospital in Ransom, KS, the cash price is $211.00, which is lower than the facility's negotiated rates of $169.00 to $240.00 depending on the insurance carrier. While the hospital is a Critical Access Hospital owned by a government district, patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the cash price often falls below the commercial negotiated rates. It is important to verify the specific "self-pay" or "prompt-pay" discount available before scheduling, as these upfront incentives can further reduce the final amount owed.
The facility's pricing is significantly higher than the Medicare benchmark of $135.60, with a ratio of 1.2 times the Medicare amount, indicating a markup typical of commercial billing structures. Commercial insurance plans such as Blue Cross Blue Shield, UnitedHealthcare, and Humana have negotiated rates ranging from $76 to $316, which are generally higher than the cash price due to administrative costs and contract dynamics. To ensure you are not overcharged, always request an itemized bill that breaks down every CPT code and unit cost, as summary bills often obscure errors or unbundled charges. If you receive a large bill, dispute any discrepancies in writing to the billing supervisor rather than accepting the summary total as final.