Office visit, established patient (30-39 min)
Facility: Hiawatha Community Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $252
- Cash Discount Price: $298
- vs. Medicare Baseline: 1.86x 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 |
|---|---|---|
| UnitedHealthcare | $74 - $385 | 55% |
| Aetna | $74 - $362 | 55% |
| Humana | $74 - $257 | 55% |
| Ambetter / Centene | $88 - $270 | 65% |
| Centrus Health Direct - All Plans | $149 - $336 | 110% |
| Oscar - All Plans | $149 - $336 | 110% |
| Preferred Hlth - All Plans | $179 - $403 | 132% |
| Blue Cross Blue Shield | $179 - $189 | 132% |
| Cigna | $189 - $426 | 139% |
| Wppa Providrs Care - All Plans | $189 - $426 | 139% |
| Midlands Choice - All Plans | $193 - $435 | 142% |
| Multiplan - All Plans | $193 - $435 | 142% |
| Healthy Blue Mcaid - All Plans | $199 - $448 | 147% |
Consumer Guidance & Cost Commentary
For this office visit code (99214) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $298.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the average commercial negotiated rates found across the region, where most payers charge between $240.00 and $448.00. While the facility's cash rate is competitive, it is important to note that commercial insurance plans often negotiate rates higher than the cash price due to administrative costs and contract structures; for instance, UnitedHealthcare and Aetna have negotiated ranges starting at $74.00 but extending up to $385.00 and $362.00 respectively. Patients with high-deductible plans may find that paying the $298.00 cash price upfront is more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash rate, potentially leading to balance billing if the patient is out-of-network.
To minimize unexpected costs, patients should verify their specific plan's deductible status and request a "self-pay" or "prompt-pay" discount before scheduling, as these programs can reduce the final bill by 20% to 50%. If a patient receives a bill that includes charges for services not rendered or unbundled components, they should request a formal itemized audit to identify errors, as over 80% of hospital bills contain inaccuracies. Additionally, while the No Surprises Act protects patients from balance billing for emergency care at in-network facilities, patients should still review their itemized statements carefully to ensure no out-of-network ancillary services triggered