Office visit, established patient (30-39 min)
Facility: F W Huston Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $139
- Cash Discount Price: $148
- vs. Medicare Baseline: 1.03x 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 | $38 - $189 | 28% |
| Cigna | $89 - $280 | 66% |
| Aetna | $90 - $248 | 66% |
| Humana | $95 - $261 | 70% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an established patient office visit lasting 30 to 39 minutes at F W Huston Medical Center in Winchester, KS, the facility's cash median rate is $148.00, while the median amount paid by insurance is $72.00. This cash price is notably lower than the facility's gross charge of $185.00 and the median negotiated rate of $139.00. Patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the cash price avoids the administrative overhead and potential balance billing associated with claims processing. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate.
When comparing this service to broader benchmarks, the Medicare amount for this procedure is $135.60, which serves as a key reference point for evaluating the facility's pricing. The cash rate of $148.00 is slightly higher than the Medicare benchmark, whereas the median paid amount of $72.00 is significantly lower, reflecting the negotiated discounts typically offered by insurers like Blue Cross Blue Shield, Cigna, Aetna, and Humana. Although specific county or state average data was not provided in the source information, the facility's location in Winchester (ZIP 66097) and its status as a Critical Access Hospital in Kansas are relevant factors for understanding local pricing dynamics. Consumers are advised to review their specific insurance coverage and deductible status before proceeding, as the final