Office visit, established patient (30-39 min)
Facility: Scott County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $186
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.37x 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 | $82 - $248 | 60% |
| Humana | $86 - $110 | 63% |
| Wppa | $122 - $1,200 | 90% |
| Aetna | $184 - $235 | 136% |
| Blue Cross Blue Shield | $189 | 139% |
Consumer Guidance & Cost Commentary
For this office visit at Scott County Hospital in Scott City, KS, the commercial negotiated rates range from $82 to $1,200 depending on your specific insurance plan, with the median negotiated amount being $186. This facility is a Critical Access Hospital owned by a voluntary non-profit, and its pricing is benchmarked against the federal Medicare rate of $135.60. The data indicates that the facility's pricing is 1.4 times the Medicare amount, which is consistent with the typical commercial markup range of 200% to 300% of Medicare, though fair pricing is often defined as 120% to 150%. While the facility is in-network for five payers including UnitedHealthcare, Humana, and Aetna, patients should be aware that in-network status does not guarantee the lowest possible price, as different insurers negotiate different ceilings.
Because commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40%, paying cash upfront can sometimes result in a lower total cost, particularly for patients with high-deductible plans where the insurance allowed amount exceeds the cash price. The facility does not list a specific cash median or negotiated rate in the provided data, but patients are strongly encouraged to ask about "self-pay" or "prompt-pay" discounts before scheduling, which can offer fee reductions of 20% to 50% by bypassing costly claims processing. To ensure you are not overcharged, always request a full itemized CPT-coded bill rather than accepting a summary invoice, and verify your deductible status before using insurance to avoid paying the full negotiated rate if you have