Office visit, established patient (30-39 min)
Facility: Cloud County Health Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $161
- Cash Discount Price: $128
- vs. Medicare Baseline: 1.19x 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 |
|---|---|---|
| Aetna | $95 - $227 | 70% |
| Pponext-All Plans | $100 - $232 | 74% |
| Mpi-All Plans | $100 - $232 | 74% |
| Health Partners - All Plans | $100 - $232 | 74% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 30 to 39 minutes, the facility's cash median rate is $128.00, which is lower than the negotiated rates paid by major payers like Aetna, Pponext-All Plans, Mpi-All Plans, and Health Partners - All Plans. While the gross charge is $182.00, patients with high-deductible plans may find paying cash directly more cost-effective, as the insurance negotiated rates often exceed the cash price. It is important to note that the median negotiated rate across these payers is $161.00, and the median amount paid by insurers is $151.00. To secure the lowest possible cost, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can significantly reduce the final bill.
This service is provided at Cloud County Health Center in Concordia, Kansas, a Critical Access Hospital owned by a voluntary non-profit. The Medicare benchmark for this procedure is $135.60, which serves as a reliable baseline for evaluating pricing fairness, as commercial rates are often marked up significantly above this figure. While specific county or state average comparisons for this exact CPT code were not included in the provided data, the facility's cash rate of $128.00 remains competitive relative to the Medicare amount. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they should still request an itemized bill to ensure no unexpected charges for services not rendered or unbundled components are included