CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Caromont Regional Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $144
Cash Discount Price: $606
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Caromont Regional Medical Center is $144. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $606. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.06x the Medicare baseline. Located in 2525 Court Dr, Gastonia, NC.

Cash / Self-Pay

$606

Average discount available for prompt cash payment at this facility.

Insurance Median

$144

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: $606 (447%)

Insurance Median: $144 (106%)

Cash: $606 (447% of Medicare)

Ins. Median: $144 (106% 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	$91 - $136	67%
Carolina Complete Health	$91	67%
Partners Behavioral Health	$91	67%
Alliance Behavioral Health	$93	69%
Amerihealth Caritas	$93	69%
Carolina Complete Health Tailored Plans	$93	69%
UnitedHealthcare	$93 - $322	69%
Vaya Behavioral Health	$93	69%
Wellcare	$93	69%
Aetna	$135 - $196	100%
Devoted Health	$136 - $143	100%
Healthteam	$136 - $143	100%
Longevity Health	$136 - $143	100%
Molina	$136 - $170	100%
Humana	$138 - $533	102%
Absolute Total Care	$170	125%
Gaston County Jail	$182	134%
Surgery Plus	$227 - $238	167%
Cigna	$241 - $253	178%
Carolina Caring	$324 - $480	239%
Corporate Benefits Service	$348 - $366	257%
Medcost	$412	304%
Self Pay	$454	335%
Beech Street	$497	367%
Multiplan	$497	367%
First Health Network	$576	425%

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 $606.
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 Caromont Regional Medical Center 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.