Office visit, established patient (30-39 min)
Facility: Graham County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $80
- Cash Discount Price: $147
- vs. Medicare Baseline: 0.59x 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 | $64 - $97 | 47% |
| Medicare (plans) | $70 | 52% |
| Medicaid / KanCare | $72 | 53% |
| Celtic Commercial-All Other Plans | $78 - $85 | 58% |
| Blue Cross Blue Shield | $80 - $111 | 59% |
| Wppa (Providers Care)-All Plans | $89 - $122 | 66% |
Consumer Guidance & Cost Commentary
For this office visit at Graham County Hospital in Hill City, Kansas, the cash price of $147.00 is the lowest possible amount a patient could pay, as it matches the facility's cash median. While insurance plans like UnitedHealthcare and Medicaid negotiate rates ranging from $64 to $122, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans should consider paying the $147.00 cash rate directly, as this bypasses the insurance billing cycle and avoids potential balance billing if the insurer's allowed amount exceeds the cash price. It is also important to verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill if paid in full upfront.
This service is benchmarked against Medicare, which sets a fixed rate of $135.60 for this procedure, serving as a reliable baseline for fair pricing. The facility's cash rate of $147.00 is slightly higher than the Medicare amount, which is common for Critical Access Hospitals in rural areas where local wage indexes and operational costs differ from the national average. Commercial negotiated rates from payers such as Blue Cross Blue Shield and Celtic Commercial range from $80 to $122, but these figures do not reflect the actual cost to the patient unless the patient has met their deductible. To ensure transparency, patients should request an itemized bill to confirm that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal audit.