CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Cheshire Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $225
Cash Discount Price: $109
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Cheshire Medical Center is $225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.66x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$109

Average discount available for prompt cash payment at this facility.

Insurance Median

$225

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: $109 (80%)

Insurance Median: $225 (166%)

Cash: $109 (80% of Medicare)

Ins. Median: $225 (166% 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
Amerihealth Caritas Nh	$35 - $105	26%
Wellsense Health Plan	$39 - $133	29%
Granite State Health Plan	$47 - $105	35%
Harvard Pilgrim Health Care Of Ne	$60 - $232	44%
Aetna	$97 - $349	72%
Ambetter / Centene	$101 - $133	74%
Blue Cross Blue Shield	$101 - $405	74%
Cigna	$101 - $315	74%
Martin'S Point Generations Advantage	$101 - $133	74%
Martin'S Point Health Care	$101 - $133	74%
Mvp	$101 - $315	74%
UnitedHealthcare	$101 - $387	74%
Wellcare Health Plans	$101 - $133	74%
Maine Community Health Options	$127 - $230	94%
Tufts Health Plan	$181 - $326	133%
First Health/Hcvm	$241 - $434	178%
Phcs	$255 - $459	188%
Mass General Brigham Health Plan	$283 - $510	209%

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 $109.
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 Cheshire 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.