Office visit, established patient (30-39 min)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $142
- Cash Discount Price: $128
- vs. Medicare Baseline: 1.05x 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 | $76 - $80 | 56% |
| UnitedHealthcare | $83 - $200 | 61% |
| Providers Care (Wppa)-All Plans | $245 - $280 | 181% |
Consumer Guidance & Cost Commentary
For this CPT code representing an established patient office visit (30-39 minutes) at the Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median rate is $128.00, which is lower than the negotiated rates paid by major payers like UnitedHealthcare ($83–$200) and Providers Care ($245–$280). While the facility is a Critical Access Hospital with government ownership, patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, as the cash price often falls below the insurer's negotiated allowed amount. It is important to note that while the facility's cash rate is competitive, the median amount actually paid by insurers ($221.00) exceeds the cash price, suggesting that for those without insurance or with high deductibles, self-pay offers the most transparent and affordable option.
When evaluating the financial value of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's gross charge. The Medicare amount for this procedure is $135.60, which serves as the objective baseline for "true cost" since it reflects actual provider expenses plus a small margin. Although the cash rate of $128.00 is slightly below the Medicare amount, patients should be aware that commercial negotiated rates can sometimes average 200% to 300% of Medicare, making the cash or self-pay option a significant savings compared to standard insurance billing. To ensure you receive the best possible price, always ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower