Office visit, established patient (30-39 min)
Facility: Lane County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $162
- Cash Discount Price: $161
- vs. Medicare Baseline: 1.19x 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 |
|---|---|---|
| Aetna | $104 - $166 | 77% |
| UnitedHealthcare | $104 - $170 | 77% |
| Medicaid / KanCare | $115 - $235 | 85% |
| Healthy Blue Mcr Adv - All Other Plans | $115 - $235 | 85% |
| Healthy Blue Mcaid | $115 - $175 | 85% |
| Wppa Providers-All Plans | $172 - $262 | 127% |
Consumer Guidance & Cost Commentary
For this established patient office visit at Lane County Hospital in Dighton, KS, the cash price is $161.00, which matches the facility's negotiated rate and the state median. While the Medicare benchmark for this service is $135.60, indicating a markup of 120% over the federal baseline, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance. This is because commercial payers like Medicaid/KanCare and Healthy Blue have negotiated rates ranging from $115 to $262, which often exceed the cash price due to administrative overhead and contract structures. To minimize costs, patients should verify their specific plan's allowed amount before scheduling and consider requesting a self-pay classification to avoid higher insurance-driven pricing.
It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected charges can still occur if ancillary services like labs or emergency care are billed separately. Consumers should always request a full itemized bill before payment to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written audit. Additionally, if you choose to pay the bill directly, ask the hospital about prompt-pay discounts, which can reduce the total amount by 20% to 50% when paid upfront, bypassing the costly claims processing cycle that inflates commercial rates.