CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: T J Samson Community Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $115
Cash Discount Price: $182
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at T J Samson Community Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $182. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.85x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$182

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $182 (134%)

Insurance Median: $115 (85%)

Cash: $182 (134% of Medicare)

Ins. Median: $115 (85% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$61 - $950	45%
Aetna	$62 - $320	46%
Humana	$62 - $320	46%
Molina Mcaid	$64 - $330	47%
Devoted Mcr Adv - All Plans	$72 - $96	53%
Wellcare Mcaid	$81 - $320	60%
Center Care Select - All Plans	$82 - $950	60%
Wellcare Mcr Adv - All Other Plans	$82	60%
Signature Health - All Plans	$83	61%
Molina Mcr Adv	$84	62%
Caresource - All Plans	$107 - $124	79%
Molina Marketplace - All Other Plans	$107 - $124	79%
UnitedHealthcare	$169 - $869	125%
Phcs/Multiplan - All Plans	$205 - $1,051	151%
First Health - All Plans	$207 - $1,062	153%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $182.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm T J Samson Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.