CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Atrium Health Lincoln

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $122
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Atrium Health Lincoln is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.90x the Medicare baseline. Located in 433 McAlister Rd, Lincolnton, NC.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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%)

Insurance Median: $122 (90%)

Ins. Median: $122 (90% 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
Trillium	$77	57%
Amerihealth Caritas	$78	58%
Carolina Complete Health	$78	58%
Healthy Blue	$78	58%
Partners	$78	58%
UnitedHealthcare	$78 - $153	58%
Vaya	$78	58%
Wellcare	$78	58%
Alliance	$79	58%
Cigna	$90 - $125	66%
Humana	$92 - $122	68%
Aetna	$93 - $269	69%
Orthocarolina	$113 - $149	83%
Blue Cross Blue Shield	$117 - $154	86%
Choicecare	$124	91%
Ambetter / Centene	$133	98%
Employers Health Network	$147	108%
Medcost	$165	122%

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 $X.
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 Atrium Health Lincoln 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.