Office visit, established patient (30-39 min)
Facility: Kiowa County Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $123
- Cash Discount Price: $117
- vs. Medicare Baseline: 0.91x 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 - $445 | 28% |
| UnitedHealthcare | $72 - $434 | 53% |
| Medicaid / KanCare | $72 - $265 | 53% |
| Humana | $77 - $445 | 57% |
| Celtic Comml Exchange-All Other Plans | $81 - $445 | 60% |
| Providrs Care/Wppa-All Plans | $81 - $398 | 60% |
| Health Partners Of Ks-All Plans | $92 - $233 | 68% |
| Aetna | $93 - $445 | 69% |
| Medica Prime Mcare Cost-All Plans | $93 - $445 | 69% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an established patient office visit lasting 30 to 39 minutes, Kiowa County Memorial Hospital in Greensburg, KS, lists a gross charge of $138.00. While the facility's cash median rate is $117.00, which is lower than the gross charge, patients with high-deductible plans may find this cash price more favorable than the negotiated rates charged to insurance payers. The data shows that insurance negotiated rates vary significantly by plan, ranging from a low of $38.00 for Blue Cross Blue Shield to a high of $445.00 for several carriers, with a median negotiated amount of $123.00. This suggests that for some policies, the cash price could result in lower out-of-pocket costs if the patient's deductible has not yet been met, though patients should verify their specific plan's allowed amount before scheduling.
To maximize potential savings, consumers should proactively request "self-pay" or "prompt-pay" discounts prior to check-in, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is important to avoid automatic claims submission if seeking a cash discount, as hospitals may submit claims to insurance carriers by default, which could void the cash agreement and lead to balance billing for the difference between the cash rate and the insurance allowed amount. Additionally, while the facility is a Critical Access Hospital with government local ownership, patients should always demand a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered.