Office visit, established patient (30-39 min)
Facility: Sheridan County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $158
- Cash Discount Price: $169
- vs. Medicare Baseline: 1.17x 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 | $53 - $169 | 39% |
| Celtic Insurance | $98 - $226 | 72% |
| UnitedHealthcare | $154 - $354 | 114% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit for an established patient lasting 30 to 39 minutes, Sheridan County Hospital in Hoxie, KS, lists a cash price of $169.00. This cash rate matches the facility's median negotiated rate of $158.00 and the cash median, suggesting that paying out-of-pocket may be more cost-effective than using insurance for this specific service, especially if your plan has a high deductible. While the facility is a Critical Access Hospital owned by the local government, patients should verify their specific plan details, as commercial payers like Blue Cross Blue Shield, Celtic Insurance, and UnitedHealthcare have negotiated ranges that start significantly higher than the cash price, with UnitedHealthcare's range extending up to $354.
When evaluating costs, it is important to compare these rates against the Medicare benchmark of $135.60, which serves as a scientifically validated baseline for the true cost of care. The facility's cash rate is 120% of the Medicare amount, aligning with the range of fair pricing typically defined between 120% and 150% of Medicare. If you choose to use insurance, be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur for out-of-network ancillary services. To minimize costs, we recommend requesting a prompt-pay discount before scheduling, which can reduce the bill by 20% to 50% if paid in full upfront, and always demand an itemized bill to ensure no errors or unbundled charges are included.