Office visit, established patient (30-39 min)
Facility: Hodgeman County Health Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $199
- Cash Discount Price: $226
- vs. Medicare Baseline: 1.47x 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 | $179 - $189 | 132% |
| Triwest - All Plans | $181 | 133% |
| UnitedHealthcare | $181 - $269 | 133% |
| Humana | $181 | 133% |
| Medicaid / KanCare | $181 - $283 | 133% |
| Aetna | $226 | 167% |
| First Health - All Plans | $255 | 188% |
| Health Partners - All Plans | $269 | 198% |
| Wppa (Provdrscare) - All Plans | $269 | 198% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the Hodgeman County Health Center in Jetmore, KS, lists a gross charge of $283.00. This amount is significantly higher than the facility's own cash median of $226.00 and the state average for this service. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance plans often negotiate rates higher than cash prices due to administrative costs and contract structures. For instance, UnitedHealthcare and Medicaid/KanCare have negotiated ranges extending up to $283.00, which matches the gross charge, whereas the cash rate remains lower.
To minimize out-of-pocket costs, patients should verify if their specific insurance plan has a negotiated rate that exceeds the cash price of $226.00, as paying cash upfront could result in immediate savings. Additionally, asking the billing department about "self-pay" or "prompt-pay" discounts before scheduling is essential, as these upfront payment incentives can further reduce the total amount owed. If you do choose to use insurance, remember that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, and you should always request a full itemized bill to ensure no unbundled codes or services not rendered are included in your final statement.