Office visit, established patient (30-39 min)
Facility: Ashland Health Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $210
- Cash Discount Price: $139
- vs. Medicare Baseline: 1.55x 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 | $42 - $88 | 31% |
| Compalliance-All Plans | $100 - $210 | 74% |
| Health Partners Of Kansas-All Plans | $106 - $223 | 78% |
| Multiplan-All Plans | $122 - $257 | 90% |
| Aetna | $125 - $262 | 92% |
| Medica Mcare - All Plans | $174 - $412 | 128% |
| UnitedHealthcare | $174 - $412 | 128% |
| Health Choice-All Plans | $174 - $412 | 128% |
| Healthy Blue Mcr Adv - All Other Plans | $174 - $412 | 128% |
| Medicaid / KanCare | $174 - $262 | 128% |
| Medicare (plans) | $174 - $412 | 128% |
| Providers Care (Wppa)-All Plans | $188 - $393 | 139% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes at Ashland Health Center in Ashland, KS, the cash median price is $139.00, while the median negotiated rate across insurance plans is $210.00. This facility, a voluntary non-profit Critical Access Hospital, has a gross charge of $174.00. It is important to note that for patients with high-deductible plans, paying the cash price of $139.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rate of $210.00 often exceeds the cash price. Additionally, patients should explicitly ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final amount owed.
When evaluating costs, it is crucial to compare rates against the Medicare benchmark rather than the facility's inflated gross charges. The Medicare amount for this service is $135.60, which serves as a scientifically validated baseline for the true cost of care. While the data provided does not include specific state or county average figures for comparison, the Medicare rate of $135.60 offers a reliable reference point to understand the facility's pricing structure. Patients should be aware that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price, making the Medicare benchmark a more accurate tool for assessing value than the facility's list price.