CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Blue Ridge Regional Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $217
  • Cash Discount Price: $523
  • vs. Medicare Baseline: 1.60x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Blue Ridge Regional Hospital is $217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $523. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.60x the Medicare baseline. Located in 125 Hospital Drive, Spruce Pine, NC.
Cash / Self-Pay
$523

Average discount available for prompt cash payment at this facility.

Insurance Median
$217

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: $523 (386%)
Insurance Median: $217 (160%)
Cash: $523 (386% of Medicare)
Ins. Median: $217 (160% 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.

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 $84 - $217 62%
United $89 - $248 66%
Wellcare $90 66%
Amerihealth $91 67%
Partners Health Management $92 68%
Vaya Health $92 68%
Aetna $105 - $378 77%
Apex Health $105 77%
Amerihealth Caritas $194 143%
Caresource $230 170%
Oscar $238 176%
Medcost $244 - $271 180%
Magellan $314 232%
Magellan Behavioral Health $314 232%
Multiplan $419 309%
Avalon Administrative Services $445 328%
Prime Health $461 - $471 340%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 125 Hospital Drive, Spruce Pine, NC 28777
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals