CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Adena Pike Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $124
Cash Discount Price: $82
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Adena Pike Medical Center is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.91x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $82 (60%)

Insurance Median: $124 (91%)

Cash: $82 (60% of Medicare)

Ins. Median: $124 (91% 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
Aetna	$40 - $134	29%
Blue Cross Blue Shield	$40 - $142	29%
Buckeye Community Health Plan	$40	29%
Care Source	$40	29%
Humana	$40 - $157	29%
Medical Mutual Of Ohio	$40 - $105	29%
Medigold	$40	29%
Molina	$40	29%
Medical Mutual Of Ohio Supermed	$42 - $124	31%
Gateway Health	$54	40%
Molina Marketplace	$65	48%
Care Source Just4Me	$71	52%
Sidecar Health	$109	80%
Ohio Ppo Connect	$115	85%
The Health Plan	$115	85%
Cigna	$119	88%
First Health	$129	95%
Ohio Health Choice	$131	97%
UnitedHealthcare	$142	105%
Integrated Health Plan	$155	114%
Healthsmart	$157	116%
Multiplan/Private Healthcare Systems	$157	116%
Three Rivers Network	$157	116%

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 $82.
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 Adena Pike 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.