Office visit, established patient (30-39 min)
Facility: Jewell County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $145
- Cash Discount Price: $123
- vs. Medicare Baseline: 1.07x 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 |
|---|---|---|
| Rural Carriers - All Plans | $94 - $178 | 69% |
| Meritain - All Plans | $100 - $189 | 74% |
| Aetna | $100 - $189 | 74% |
| Midlands Choice - All Plans | $105 - $200 | 77% |
| Cigna | $105 - $200 | 77% |
| First Health - All Plans | $105 - $200 | 77% |
| UnitedHealthcare | $105 - $200 | 77% |
Consumer Guidance & Cost Commentary
For this office visit to an established patient lasting 30 to 39 minutes, the facility's cash price of $123.00 is lower than the median negotiated rate of $145.00 and the median amount paid by insurance of $136.00. While the gross charge listed is $164.00, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and multi-layered billing structures. If you have a high-deductible plan, paying the cash price upfront might be more cost-effective than using insurance, especially since the negotiated rate exceeds the cash price. You can often reduce this amount further by asking the hospital directly about "self-pay" or "prompt-pay" discounts, which may offer an additional reduction for upfront payment.
The Medicare benchmark for this service is $135.60, which serves as a scientifically validated baseline for evaluating pricing markups. In this case, the facility's cash rate is approximately 91% of the Medicare amount, while the median negotiated rate is roughly 107% of Medicare. It is important to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster list, as the latter is inflated to make discounts appear larger than they are. Additionally, under federal protections like the No Surprises Act, you are generally shielded from balance billing for out-of-network services at in-network facilities, though you should always request an itemized bill to verify that no unbundled codes or services not rendered have been included.