Office visit, established patient (30-39 min)
Facility: William Newton Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $156
- Cash Discount Price: $347
- vs. Medicare Baseline: 1.15x 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 |
|---|---|---|
| Ambetter / Centene | $72 - $449 | 53% |
| Triwest- All Plans | $74 - $157 | 55% |
| Blue Cross Blue Shield | $76 - $179 | 56% |
| UnitedHealthcare | $76 - $404 | 56% |
| Providrs Care Nexus | $129 - $275 | 95% |
| Providrs Care - All Other Plans | $148 - $314 | 109% |
Consumer Guidance & Cost Commentary
For the CPT code 99214 representing an office visit with an established patient (30-39 minutes), the cash price at William Newton Hospital in Winfield, KS, is $347.00. This cash rate matches the facility's median paid amount and is significantly higher than the state average, which is 120% of the Medicare benchmark of $135.60. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should be aware that commercial insurance negotiated rates vary widely across payers, ranging from a low of $72 to a high of $449. In many cases, paying cash directly can be more cost-effective than using insurance if the patient's plan has a high deductible, as the negotiated rate often exceeds the cash price.
To ensure you are receiving the most accurate pricing, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you choose to pay out-of-pocket, ask specifically about self-pay or prompt-pay discounts, which can reduce the total by 20% to 50% and bypass costly administrative processing fees. Additionally, while the facility offers a 4-star rating, always verify your specific plan's allowed amount with the hospital prior to scheduling, as assuming that an in-network status guarantees the lowest possible price is a common pitfall.