Office visit, established patient (30-39 min)
Facility: Holton Community Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $110
- Cash Discount Price: $152
- vs. Medicare Baseline: 0.81x 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 |
|---|---|---|
| UnitedHealthcare | $58 - $450 | 43% |
| Aetna | $58 - $450 | 43% |
| Humana | $59 - $241 | 44% |
| Kansas Superior Select - All Plans | $59 - $243 | 44% |
| Medicaid / KanCare | $72 - $450 | 53% |
| Blue Cross Blue Shield | $80 | 59% |
| Preferred Health Professionals | $91 - $374 | 67% |
| Preferred Health Freedom | $91 - $374 | 67% |
| Preferred Health Fn Select - All Other Plans | $91 - $374 | 67% |
| Wppa Providers - All Plans | $104 - $428 | 77% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the cash median price at Holton Community Hospital in Holton, KS is $152.00. This cash rate is notably lower than the negotiated rates paid by most commercial payers, such as UnitedHealthcare and Aetna, which range from $58 to $450 depending on the specific plan. While the facility's negotiated median is $110.00, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $152.00. It is important to note that while the facility is a Critical Access Hospital in Kansas, the data provided does not include specific county or state average comparisons for this procedure, so local benchmarks cannot be applied here.
The Medicare benchmark for this service is $135.60, which serves as a scientifically validated baseline for evaluating pricing fairness. Commercial negotiated rates often exceed this benchmark due to administrative costs and contract dynamics, yet the cash price remains competitive. Patients should be aware of the "prompt-pay" discount opportunity, where paying the bill in full upfront can sometimes yield a fee reduction of 20% to 50%, bypassing the costly insurance claims processing cycle. To avoid balance billing or unexpected charges, patients should explicitly request self-pay classification and a waiver of insurance submission before check-in, ensuring the facility bills them only the agreed-upon cash rate rather than the full chargemaster.