Office visit, established patient (30-39 min)
Facility: Clara Barton Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $113
- Cash Discount Price: $88
- vs. Medicare Baseline: 0.83x 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 | $80 | 59% |
| 6 Degrees Health - All Plans | $88 | 65% |
| Wppa-All Plans | $101 | 74% |
| Aetna | $113 | 83% |
| Phcs - All Plans | $113 | 83% |
| UnitedHealthcare | $113 | 83% |
| Hlth Partners Of Ks-All Plans | $116 | 86% |
Consumer Guidance & Cost Commentary
For CPT code 99214, an office visit with an established patient lasting 30 to 39 minutes, Clara Barton Hospital in Hoisington, KS, lists a gross charge of $126.00. While the facility's cash median rate is $88.00, which is lower than the gross charge, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rate across payers is $113.00, and the median paid amount is $115.00. Because the negotiated rate ($113.00) is higher than the cash price ($88.00), patients with high-deductible plans or those who have already met their deductible may find it financially advantageous to pay the cash price directly. It is recommended to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final amount owed.
When evaluating pricing against federal benchmarks, the Medicare amount for this service is $135.60. The facility's cash rate of $88.00 represents a ratio of 0.8 relative to the Medicare amount, indicating it is priced below the federal baseline. However, the commercial negotiated rates average 113.00, which is approximately 83% of the Medicare benchmark. This pricing structure highlights that while the facility's cash rates are competitive compared to the Medicare standard, the actual cost to insured patients depends heavily on their specific plan's negotiated rates. Given that the facility is a Critical Access Hospital with a voluntary non