Office visit, established patient (30-39 min)
Facility: Ellsworth County Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $197
- Cash Discount Price: $197
- vs. Medicare Baseline: 1.45x 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 | $36 - $111 | 27% |
| Coventry Mcaid-All Plans | $72 - $646 | 53% |
| Healthy Blue Mcaid- All Other Plans | $72 - $646 | 53% |
| Medicaid / KanCare | $72 - $646 | 53% |
| UnitedHealthcare | $72 - $646 | 53% |
| Triwest -All Plans | $81 - $303 | 60% |
| Va Ccn-All Plans | $81 - $303 | 60% |
| Aetna | $97 - $581 | 72% |
| Providers Care-Wppa-All Plans | $122 - $968 | 90% |
| Cigna | $172 - $613 | 127% |
| First Health - All Plans | $177 - $581 | 131% |
| Humana | $187 - $613 | 138% |
| Healthy Blue Mcr Adv | $258 - $303 | 190% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the facility's cash price is $197.00, which matches the median negotiated rate across 13 payers. While the gross charge listed is $197.00, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures; in this case, the median amount paid by insurers is $222.00. It is important to note that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $197.00 upfront may result in lower total costs compared to using insurance, which could lead to higher out-of-pocket expenses once deductibles are applied.
This service is provided at Ellsworth County Medical Center, a Critical Access Hospital in Ellsworth, Kansas (ZIP 67439), with a facility rating of 2. The Medicare benchmark for this procedure is $135.60, serving as the objective baseline for evaluating pricing markups. Commercial rates in this region typically range from 200% to 300% of the Medicare amount, whereas fair pricing is generally defined as 120% to 150% of the Medicare rate. Patients are encouraged to verify their specific insurance allowed amounts before scheduling, as in-network rates vary significantly by carrier. Additionally, asking the billing department about "self-pay" or "prompt-pay" discounts prior to check-in can help secure immediate fee reductions, as hospitals often offer 20% to 50% off for