Office visit, established patient (30-39 min)
Facility: Greenwood County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $213
- Cash Discount Price: $204
- vs. Medicare Baseline: 1.57x 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 - $38 | 27% |
| Triwest - All Plans | $89 - $93 | 66% |
| UnitedHealthcare | $105 - $218 | 77% |
| Tricare | $105 - $109 | 77% |
| Choicecare Mcr Adv - All Plans | $105 - $109 | 77% |
| Integrated Health Plan - All Plans | $188 - $195 | 139% |
| First Health - All Other Plans | $212 - $221 | 156% |
| Beech Street - All Plans | $212 - $221 | 156% |
| First Health Ccn Network | $212 - $221 | 156% |
| Preferred Hs (Coventry) - All Plans | $225 - $234 | 166% |
| Principal Health Care Inc - All Plans | $238 - $247 | 176% |
| Medicaid / KanCare | $250 - $260 | 184% |
| Amerigroup Mcaid-All Plans | $250 - $260 | 184% |
| Providrs Care/Wppa - All Plans | $375 - $390 | 277% |
Consumer Guidance & Cost Commentary
For CPT code 99214, an office visit with an established patient lasting 30 to 39 minutes, Greenwood County Hospital in Eureka, Kansas, lists a gross charge of $255.00. While the facility's cash median rate is $204.00, which is lower than the gross charge, the negotiated rates paid by insurance plans range from $36.00 to $390.00 depending on the carrier. Notably, the lowest negotiated rates from Blue Cross Blue Shield ($36.00–$38.00) and Triwest ($89.00–$93.00) are significantly lower than the cash price, suggesting that for patients with high-deductible plans, using insurance may result in lower out-of-pocket costs than paying cash. However, patients should verify their specific plan's deductible status and allowed amount before scheduling, as paying the full cash price upfront could be more expensive if their insurance requires them to meet a deductible first.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's gross list price. The Medicare amount for this procedure is $135.60, which serves as the objective baseline for fair pricing. The facility's cash rate of $204.00 represents a markup of approximately 50% over the Medicare rate, while the highest negotiated rates from providers like Providrs Care/Wppa ($375.00–$390.00) exceed the cash price. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services