Office visit, established patient (30-39 min)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $121
- Cash Discount Price: $117
- vs. Medicare Baseline: 0.89x 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 |
|---|---|---|
| Humana | $51 - $98 | 38% |
| Blue Cross Blue Shield | $52 - $258 | 38% |
| Tricare | $56 - $106 | 41% |
| Medicaid / KanCare | $72 - $264 | 53% |
| UnitedHealthcare | $72 - $264 | 53% |
| Healthy Blue Mcaid - All Plans | $72 - $200 | 53% |
| Va Ccn - All Plans | $81 - $124 | 60% |
| Aetna | $85 - $180 | 63% |
| Ambetter / Centene | $85 - $264 | 63% |
| Health Partners - All Plans | $100 - $190 | 74% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit for an established patient lasting 30 to 39 minutes, the facility's cash median rate is $117.00, while the median negotiated rate across ten payers is $121.00. This indicates that for patients with high-deductible plans, paying cash directly may result in lower out-of-pocket costs compared to using insurance, as the negotiated rates often exceed the cash price. It is important to note that while the facility is a Critical Access Hospital in Wakeeney, KS, the data provided does not include specific county or state average comparisons for this specific code, so patients should verify local pricing benchmarks directly with the hospital or their insurance carrier.
Patients should be aware that commercial negotiated rates often include administrative overhead and contract dynamics that can make them higher than the actual cost of care, which is reflected in the Medicare benchmark of $135.60 for this service. To maximize savings, individuals should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final bill. Additionally, if a patient receives a large post-service bill, they should request a full itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be resolved through formal written disputes.