Office visit, established patient (30-39 min)
Facility: Rooks County Health Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $112
- Cash Discount Price: $133
- vs. Medicare Baseline: 0.83x 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 |
|---|---|---|
| Veterans Admin - All Plans | $69 - $98 | 51% |
| Tricare | $69 - $98 | 51% |
| Celtic Mcr Adv | $69 - $98 | 51% |
| Healthy Blue Mcaid - All Plans | $72 - $208 | 53% |
| Celtic Comm - All Other Plans | $76 - $108 | 56% |
| UnitedHealthcare | $93 - $188 | 69% |
| Preferred Hlthcare - All Other Plans | $94 - $198 | 69% |
| Preferred Benefits Admin | $94 - $188 | 69% |
| Blue Cross Blue Shield | $112 - $189 | 83% |
| Aetna | $128 - $188 | 94% |
| Health Partners - All Plans | $139 - $198 | 103% |
Consumer Guidance & Cost Commentary
For CPT code 99214, an office visit with an established patient lasting 30 to 39 minutes, the gross charge at Rooks County Health Center in Plainville, Kansas, is $178.00. While the facility's cash median price is $133.00 and the median negotiated rate across 11 payers is $112.00, these figures are notably lower than the Medicare benchmark of $135.60. This suggests that for patients with high-deductible plans, paying cash directly might be more cost-effective than relying on insurance, as the negotiated rates often include administrative overhead that inflates the baseline price. It is important to note that while the facility is a Critical Access Hospital owned by a government hospital district, the specific negotiated rates vary significantly by insurer, ranging from a low of $69 to a high of $198 depending on the payer.
Patients should be aware that assuming in-network status guarantees the lowest possible price is a common pitfall, as different insurers contract with facilities at varying tiers. To minimize costs, individuals should verify their specific plan's allowed amount before scheduling and explicitly request "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount when paid upfront. Furthermore, because over 80% of hospital bills contain errors, consumers should always demand a full itemized CPT-coded statement rather than accepting a summary bill, and they should compare all charges against the Medicare rate to ensure they are not overpaying for services rendered.