Office visit, established patient (30-39 min)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $199
- Cash Discount Price: $264
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Tricare | $85 - $211 | 63% |
| Humana | $96 - $240 | 71% |
| Aetna | $98 - $265 | 72% |
| UnitedHealthcare | $101 - $251 | 74% |
| Hpk-All Plans | $101 - $252 | 74% |
| Medicaid / KanCare | $106 - $264 | 78% |
Consumer Guidance & Cost Commentary
For this office visit at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $264.00, which matches the facility's median negotiated rate. While the hospital is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that commercial insurance rates for this service can vary significantly. For instance, Tricare plans pay as low as $85, while Aetna plans can pay up to $265, with most negotiated rates falling between $96 and $265 across six different payers. Because commercial negotiated rates often include administrative overhead and contract markups, paying cash upfront can sometimes result in a lower total cost than what your insurance allows, especially if you have a high deductible plan.
To ensure you are not overcharged, it is recommended to request a prompt-pay discount before scheduling your appointment, as hospitals often offer immediate fee reductions for upfront payment. Additionally, if you receive a bill from an out-of-network provider or encounter unexpected charges, you may be subject to balance billing, which is the practice of being billed for the difference between the provider's full charge and your insurance's allowed amount. However, federal protections under the No Surprises Act ban balance billing for emergency care and non-emergency services at in-network facilities. If you do receive a surprise bill, you should dispute it in writing rather than paying immediately, and always request a detailed, itemized bill to verify that no services were rendered or codes were unbundled before finalizing any payment.