Office visit, established patient (30-39 min)
Facility: Morris County Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $166
- Cash Discount Price: $173
- vs. Medicare Baseline: 1.22x 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 | $36 - $189 | 27% |
| Choice Care Mcr Adv-All Plans | $78 - $147 | 58% |
| UnitedHealthcare | $78 - $378 | 58% |
| Coventry Mcr | $78 - $147 | 58% |
| Va Ccn-All Plans | $78 - $147 | 58% |
| Cigna | $145 - $273 | 107% |
| Aetna | $179 - $339 | 132% |
| Multiplan-All Plans | $180 - $340 | 133% |
| Coventry Comm-All Other Plans | $180 - $340 | 133% |
| Providrs Care (Wppa)(Nexus)-All Plans | $300 - $567 | 221% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, Morris County Hospital in Council Grove, KS, lists a gross charge of $289.00. This amount is significantly higher than the facility's own negotiated rate of $166.00 and exceeds the cash median of $173.00. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this case, paying cash directly could result in a lower out-of-pocket cost than using an in-network plan, provided the patient's deductible has been met.
The facility's pricing is benchmarked against Medicare, which sets a fixed rate of $135.60 for this service. The commercial negotiated rates observed across ten payers range from $36.00 to $567.00, with the lowest allowed amount being $36.00 from Blue Cross Blue Shield and the highest at $567.00 from Providrs Care. Because these rates vary widely by payer and plan, patients are advised to verify their specific allowed amount before scheduling. Additionally, since the facility offers prompt-pay discounts for upfront payment, patients should contact the billing department prior to check-in to request a self-pay classification and potential fee reduction, ensuring they do not inadvertently trigger automatic claims submission that would void any cash savings.