Office visit, established patient (30-39 min)
Facility: Stevens County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $276
- Cash Discount Price: $317
- vs. Medicare Baseline: 2.04x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 204% of the Medicare baseline (a markup of 104%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 - $38 | 27% |
| Humana | $117 | 86% |
| Aetna | $121 - $317 | 89% |
| First Health - All Plans | $285 | 210% |
| Wppa - All Plans | $301 | 222% |
| Medicaid / KanCare | $317 | 234% |
Consumer Guidance & Cost Commentary
For this office visit at Stevens County Hospital in Hugoton, Kansas, the cash price is $317.00, which matches the facility's gross chargemaster rate. While commercial insurance plans like Aetna and Humana have negotiated rates ranging from $117 to $317, these amounts often exceed the cash price, meaning self-pay patients could save money by paying directly. It is important to note that Medicaid/KanCare and First Health - All Plans have fixed negotiated rates of $285 and $301 respectively, which are slightly lower than the cash price but still higher than the facility's cash median. Patients should verify their specific plan's deductible status before scheduling, as paying out-of-pocket may be more cost-effective if the insurance allowed amount is higher than the cash rate.
To ensure you are not overcharged, always request an itemized bill before paying, as summary bills can hide unbundled codes or services not rendered. If you receive a balance bill for an out-of-network service, you may be entitled to protections under the No Surprises Act, which bans surprise billing for emergency care and non-emergency services at in-network facilities. Additionally, ask the hospital about prompt-pay discounts, which can reduce your bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims. This facility is a Critical Access Hospital with a government-local ownership structure, and while the facility rating is 4, the most significant savings opportunity lies in comparing the cash price against your specific insurance allowed amount rather than relying on the hospital's gross charges.