Office visit, established patient (30-39 min)
Facility: Girard Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $174
- Cash Discount Price: $111
- vs. Medicare Baseline: 1.28x 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 | $38 - $247 | 28% |
| Ambetter / Centene | $49 - $247 | 36% |
| UnitedHealthcare | $49 - $473 | 36% |
| Humana | $49 - $247 | 36% |
| Kansas Superior Select-All Plans | $49 - $247 | 36% |
| Medicare (plans) | $49 - $247 | 36% |
| Aetna | $49 - $872 | 36% |
| Multiplan-All Plans | $87 - $461 | 64% |
| Uhhis-All Plans | $116 - $473 | 86% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, Girard Medical Center in Kansas has a gross charge of $185.00. While the facility's cash median rate is $111.00, which is lower than the negotiated rates paid by insurance plans ranging from $49 to $872, patients should be aware that commercial insurance often results in higher out-of-pocket costs due to administrative fees and contract structures. The facility's negotiated rate of $174.00 is notably higher than the Medicare benchmark of $135.60, suggesting a markup of 1.3 times the federal rate. Because commercial rates frequently exceed cash prices, individuals with high-deductible plans may find paying the cash median of $111.00 directly more economical than relying on insurance, provided they have not yet met their deductible.
To minimize unexpected costs, patients should actively request a prompt-pay discount before scheduling or check-in, as paying in full upfront can significantly reduce the final bill compared to the standard cash median. It is also critical to demand an itemized billing audit rather than accepting a summary bill, as over 80% of hospital invoices contain errors such as unbundled codes or services not rendered. If a patient receives a balance bill from an out-of-network provider, they should not pay immediately out of fear of credit damage; instead, they should dispute the charge with their insurer and request a No Surprises Act audit. Finally, since this facility is a Critical Access Hospital owned by a Government Hospital District, patients should verify if specific self-pay or prompt-pay discounts are available