Office visit, established patient (30-39 min)
Facility: Bob Wilson Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $252
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.86x 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 | $252 | 186% |
Consumer Guidance & Cost Commentary
For this CPT code representing an office visit with an established patient, the facility has a single negotiated rate of $252.00 with Blue Cross Blue Shield. This rate is significantly higher than the Medicare benchmark of $135.60, reflecting the standard administrative markup inherent in commercial insurance contracts. While the facility is a Critical Access Hospital in Ulysses, KS, no cash or median paid data is available for this service, meaning patients without insurance coverage cannot currently access the potential savings of paying directly.
To minimize costs, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payments can sometimes be lower than the insurance negotiated rate, particularly for those with high-deductible plans. If you do receive a bill, it is critical to request a full itemized statement rather than accepting a summary invoice, as hospitals often obscure individual charges to facilitate errors or unbundling. Always compare the final allowed amount against the Medicare rate to ensure the facility is charging a fair price relative to the true cost of care.