Office visit, established patient (30-39 min)
Facility: Phillips County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $160
- Cash Discount Price: $136
- vs. Medicare Baseline: 1.18x 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 | $38 - $242 | 28% |
| UnitedHealthcare | $92 - $170 | 68% |
| Medicaid / KanCare | $115 - $170 | 85% |
| Health Partners-All Plans | $115 - $170 | 85% |
Consumer Guidance & Cost Commentary
For this office visit to an established patient at Phillips County Hospital in Phillipsburg, KS, the negotiated rates range from $38 to $242 depending on your specific insurance plan, with Blue Cross Blue Shield offering the lowest range and UnitedHealthcare and Medicaid/KanCare falling between $92 and $170. The facility's cash price of $136 is notably lower than the median negotiated amount of $165, which aligns closely with the median negotiated rate of $160 found across the region. While the gross charge listed is $160, patients with high-deductible plans may find paying the cash price of $136 more cost-effective than relying on insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics.
To ensure you receive the best possible rate, it is essential to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier. If you choose to pay out-of-pocket, ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the cost by bypassing the administrative fees associated with insurance claims processing. Additionally, since this facility is a Critical Access Hospital with government local ownership, you should request an itemized bill to review every charge and confirm that no balance billing has occurred, as federal protections generally prevent surprise bills for services rendered at in-network facilities.