Office visit, established patient (30-39 min)
Facility: Nemaha Valley Community Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $111
- Cash Discount Price: $225
- vs. Medicare Baseline: 0.82x 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% |
| Humana | $42 - $110 | 31% |
| Va Ccn - All Plans | $42 - $110 | 31% |
| Aetna | $42 - $329 | 31% |
| Celtic Comm Exch - All Plans | $46 - $329 | 34% |
| Partners Direct Health - All Plans | $49 - $130 | 36% |
| Multiplan - All Plans | $86 - $225 | 63% |
| Health Partners - All Plans | $90 - $238 | 66% |
| Midlands Choice - All Plans | $90 - $238 | 66% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an established patient office visit lasting 30 to 39 minutes, Nemaha Valley Community Hospital in Seneca, KS, lists a gross charge of $250.00. While the facility's cash median is $225.00, which is lower than the state average, patients should be aware that insurance negotiated rates often exceed cash prices. For example, Aetna and Celtic Comm Exch have negotiated rates as high as $329.00, meaning paying out-of-pocket could result in significant savings compared to using insurance. Additionally, the facility offers a prompt-pay discount, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the administrative costs and delays associated with insurance claims processing.
The Medicare benchmark for this service is $135.60, serving as a reliable baseline to evaluate pricing fairness. The facility's cash median of $225.00 is approximately 1.66 times the Medicare rate, while the median negotiated rate across payers is $111.00. To minimize costs, patients should verify their deductible status before scheduling, as high negotiated rates may only be covered after meeting out-of-pocket limits. If you are self-pay or have a high-deductible plan, it is advisable to request a formal itemized bill and confirm any "self-pay" or "prompt-pay" discounts prior to check-in to avoid unexpected balance billing or administrative fees.