Office visit, established patient (30-39 min)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $97
- Cash Discount Price: $188
- vs. Medicare Baseline: 0.72x 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 |
|---|---|---|
| UnitedHealthcare | $58 - $265 | 43% |
| Aetna | $81 - $168 | 60% |
| Blue Cross Blue Shield | $112 - $189 | 83% |
Consumer Guidance & Cost Commentary
For this office visit at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price of $188.00 is identical to the facility's self-pay rate and the median amount paid by patients without insurance. While the facility's negotiated rates with major payers like UnitedHealthcare, Aetna, and Blue Cross Blue Shield range from $58 to $265, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash price of $188.00 upfront, as this avoids the potential for the insurance negotiated rate to exceed the cash amount. It is important to verify the specific "self-pay" or "prompt-pay" discount available at the time of registration, as these upfront payment incentives can significantly reduce the final cost compared to standard billing cycles.
The Medicare benchmark for this service is $135.60, which serves as a baseline for evaluating the facility's pricing markup. The cash price of $188.00 represents a 38% increase over the Medicare rate, while the median negotiated rate of $97.00 falls below the cash price, suggesting that in-network members may pay less than the self-pay rate depending on their specific plan. To ensure you are receiving the most accurate pricing, always request a full itemized bill before paying, as summary invoices can obscure individual charges and potential errors. If you receive a bill that does not break down specific CPT codes or supplies, you should formally dispute it in writing to avoid overpaying for unbundled services or items that were not rendered.