Office visit, established patient (30-39 min)
Facility: Decatur Health
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $130
- Cash Discount Price: $212
- vs. Medicare Baseline: 0.96x 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 | $49 - $145 | 36% |
| Aetna | $72 - $247 | 53% |
| UnitedHealthcare | $73 - $207 | 54% |
| Medicaid / KanCare | $73 - $250 | 54% |
| Wppa/Providrs Care- All Plans | $87 - $163 | 64% |
| Humana | $89 - $167 | 66% |
| Midlands Choice- All Plans | $122 - $244 | 90% |
Consumer Guidance & Cost Commentary
For this established patient office visit at Decatur Health in Oberlin, Kansas, the cash price of $212.00 is notably lower than the facility's negotiated rates with major insurers like Aetna ($72–$247) and UnitedHealthcare ($73–$$207). While the cash price is higher than the median amount paid by insurance ($146.00), it remains significantly below the gross chargemaster of $236.00. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. To secure the lowest possible price, it is recommended to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final bill.
The facility's pricing aligns closely with the Medicare benchmark of $135.60, with a negotiated average of $130.00 across all payers, suggesting a fair market value relative to federal cost standards. This CPT code represents a standard 30-to-39 minute office visit, and the facility, a voluntary non-profit Critical Access Hospital, maintains a transparent pricing structure typical of the region. Consumers should be aware that while insurance contracts set a ceiling on what providers can charge, the actual amount paid depends on individual plan deductibles and negotiated allowances. Always verify your specific plan's allowed amount before scheduling to avoid unexpected out-of-pocket costs, and remember that the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities.