CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Cox Medical Centers

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $108
Cash Discount Price: $77
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Cox Medical Centers is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.80x the Medicare baseline. Located in 3801 South National Avenue, Springfield, MO.

Cash / Self-Pay

$77

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $77 (57%)

Insurance Median: $108 (80%)

Cash: $77 (57% of Medicare)

Ins. Median: $108 (80% 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
Cox Healthplans	$82	60%
Health Net Federal Services	$82	60%
Humana	$82 - $125	60%
Medrisk Llc	$82	60%
UnitedHealthcare	$82	60%
Blue Cross Blue Shield	$83	61%
Allwell	$85	63%
Devoted	$88	65%
Provider Partners Health Plan	$88	65%
Parkcrest Dental Group	$99	73%
Coastal Energy Corporation	$100	74%
Heart Of America Beverage Company	$102	75%
Loren Cook	$104	77%
Springfieldgreene Co Library	$106	78%
Src Holdings Corporation	$107	79%
Ozark Anesthesia Assoc. Inc	$108	80%
United Behavioral Health	$108	80%
Justice Furniture And Bedding Co	$111	82%
Missouri Affiliated School Consortium (Masc)	$111	82%
The Durham Company	$111	82%
Ozark County	$112	83%
Ozarks Cocacola	$113	83%
Flora Farms	$115	85%
Advanced Concrete Technology	$116	86%
Compsych	$118	87%
Magellan	$130	96%
Aps Healthcare	$145	107%
Interface Eap	$179	132%
E4 Health Inc	$180	133%
Texas Co Memorial Hospital	$185	136%
Bjc Health Solutions	$199	147%
Cigna	$200	147%
Mercy Managed	$273	201%

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 $77.
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 Cox Medical Centers 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.