Office visit, established patient (30-39 min)
Facility: Ellinwood District Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $91
- Cash Discount Price: $111
- vs. Medicare Baseline: 0.67x 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 |
|---|---|---|
| Humana | $78 - $182 | 58% |
| UnitedHealthcare | $78 - $182 | 58% |
| Aetna | $78 - $182 | 58% |
| Cigna | $78 - $182 | 58% |
| Blue Cross Blue Shield | $78 - $182 | 58% |
Consumer Guidance & Cost Commentary
For this office visit at Ellinwood District Hospital in Kansas, the cash price is $111.00, which is lower than the facility's gross charge of $130.00. While the hospital is a Critical Access Hospital owned by a government district, patients with high-deductible plans might find paying cash directly more affordable than using insurance, as the negotiated rates for major payers like Humana, UnitedHealthcare, and Aetna range from $78 to $182. Because commercial insurance contracts often include administrative overheads that inflate the baseline price, the cash price can sometimes represent a better value than the allowed amount your insurer would pay.
To ensure you are not overcharged, it is important to request a full itemized bill before paying, as summary bills often hide errors or unbundled charges. Additionally, you should ask the billing department about "prompt-pay" discounts, which can reduce the final amount if you settle the bill upfront, and verify that any balance billing you receive complies with the No Surprises Act. For context on regional pricing, the Medicare benchmark for this service is $135.60, which serves as a reliable baseline to evaluate whether the facility's commercial rates are reasonable compared to the federal standard.