Office visit, established patient (30-39 min)
Facility: Fredonia Regional Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $169
- Cash Discount Price: $215
- vs. Medicare Baseline: 1.25x 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 |
|---|---|---|
| Aetna | $50 - $298 | 37% |
| Cigna | $89 - $298 | 66% |
| Reserve National-All Plans | $89 - $298 | 66% |
| UnitedHealthcare | $89 - $298 | 66% |
| Meritain-All Plans | $89 - $298 | 66% |
| Veterans Programs - All Plans | $152 - $169 | 112% |
| Blue Cross Blue Shield | $152 - $189 | 112% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the cash price at Fredonia Regional Hospital in Kansas is $215.00. This cash rate matches the facility's median paid amount and is significantly higher than the Medicare benchmark of $135.60, which serves as the objective baseline for evaluating pricing markups. While the facility is a Critical Access Hospital in a rural area (Zip 66736), the cash price does not align with typical state or county averages for this service, suggesting a markup relative to the federal cost basis. Patients with high-deductible plans should consider that paying cash upfront at $215.00 might be more cost-effective than using insurance, as commercial negotiated rates for this service can sometimes exceed the cash price due to administrative overhead and contract structures.
Insurance coverage varies widely across the seven payers represented in this data. For example, Aetna plans have a range of $50 to $298, while Veterans Programs offer a lower range of $152 to $169. The median negotiated rate across all payers is $169.00, which is still above the Medicare amount but below the cash price. It is important to note that patients should verify their specific deductible status before scheduling, as using insurance may result in out-of-pocket costs that exceed the cash rate if the deductible has not been met. Additionally, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypass