Office visit, established patient (30-39 min)
Facility: Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $180
- Cash Discount Price: $200
- vs. Medicare Baseline: 1.33x 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 |
|---|---|---|
| Tricare | $74 - $285 | 55% |
| Medicare (plans) | $74 - $288 | 55% |
| Humana | $74 - $285 | 55% |
| Ambetter / Centene | $81 - $314 | 60% |
| Blue Cross Blue Shield | $85 | 63% |
| Coventry - All Other Plans | $133 - $513 | 98% |
| Health Partners Of Kansas - All Plans | $140 - $542 | 103% |
| Preferred Healthcare-All Plans | $140 - $542 | 103% |
| Wppa/Providers Care-All Plans | $206 - $798 | 152% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 30 to 39 minutes, the cash price at Memorial Hospital in Abilene is $200.00, which matches the facility's median negotiated rate of $180.00 and the state average. While commercial payers like Wppa/Providers Care and Coventry have negotiated rates ranging up to $798 and $513 respectively, the cash price remains the most transparent benchmark for patients. It is important to note that for individuals with high-deductible plans, paying the full cash price of $200.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for many plans significantly exceed this amount. Patients should verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final balance before any insurance processing occurs.
The facility operates as a Critical Access Hospital in Kansas, and its pricing is evaluated against the Medicare benchmark of $135.60, which serves as the objective baseline for healthcare costs. The cash price of $200.00 represents a markup of 1.3 times the Medicare rate, aligning with fair pricing standards that typically range between 120% and 150% of the federal baseline. If you receive a bill from this facility, you should request a detailed itemized statement to ensure no errors, such as unbundled codes or services not rendered, have inflated your charges. Be aware that while the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, you must still review your itemized bill