Office visit, established patient (30-39 min)
Facility: Hamilton County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $137
- Cash Discount Price: $159
- vs. Medicare Baseline: 1.01x 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 | $18 - $189 | 13% |
| First Health Coventry - All Plans | $119 - $151 | 88% |
| UnitedHealthcare | $133 - $169 | 98% |
| Cigna | $133 - $169 | 98% |
| Va Ccn - All Plans | $140 | 103% |
| Aetna | $238 - $366 | 176% |
Consumer Guidance & Cost Commentary
For this office visit at Hamilton County Hospital in Syracuse, KS, the cash price is $159.00, which matches the facility's negotiated rate for patients with no insurance. While the facility is a Critical Access Hospital owned by the local government, the cash price is notably higher than the state average for this service. Patients with high-deductible plans may find paying the full cash price of $159.00 more affordable than using insurance, as the negotiated rates for major payers like Aetna ($238–$366) and UnitedHealthcare ($133–$169) often exceed the cash amount. To minimize costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the final bill by 20% to 50%.
The Medicare benchmark for this procedure is $135.60, which serves as a reliable baseline for evaluating the facility's pricing markup. Although the cash price is higher than the Medicare rate, it is significantly lower than the gross charges that would apply if a patient were out-of-network, where balance billing could result in unexpected bills for the difference between the chargemaster and the insurance allowed amount. Under federal protections like the No Surprises Act, balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities, but patients should still verify their network status to avoid any potential issues. If you receive an itemized bill, request a full line-by-line audit to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through