CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Blount Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $125
Cash Discount Price: $59
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Blount Memorial Hospital is $125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.92x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$125

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: $59 (44%)

Insurance Median: $125 (92%)

Cash: $59 (44% of Medicare)

Ins. Median: $125 (92% 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
Medicaid / KanCare	$16 - $113	12%
UnitedHealthcare	$16 - $133	12%
Prisma Health Seniorcare Pace - Midlands [5400]	$24 - $64	18%
Prisma Health Seniorcare Pace-Upstate [5200]	$24 - $64	18%
Promise Health Plan Contracted [2401]	$36 - $165	27%
Orangeburg Senior Helping Center Pace [5401]	$41 - $110	30%
Cigna	$57 - $170	42%
Blue Cross Blue Shield	$58 - $154	43%
Bob Jones Univ-Pai [821]	$62 - $165	46%
Preferred Administrators Contracted [2839]	$72 - $192	53%
Medcost [2940]	$76 - $228	56%
Atlantic Packaging Contracted [4833]	$77 - $206	57%
Aps Healthcare System [2981]	$82 - $220	60%
Multiplan/Phcs Contracted [2950]	$92 - $245	68%
Aetna	$93 - $248	69%
Meritain Health Contracted [2200]	$93 - $248	69%
Nippon [2300]	$93 - $248	69%
Vsp Vision Care [2986]	$93 - $248	69%
Tricare	$94 - $120	69%
First Health Contracted [2952]	$96 - $256	71%
Furman Int/Allen University Student [2951]	$96 - $256	71%
Quiktrip-First Health [3067]	$96 - $256	71%
Mvp Health Care [3037]	$97 - $170	72%
Humana	$125 - $130	92%
Medicare (plans)	$125 - $134	92%
Ambetter / Centene	$196 - $201	145%
Consociate Health Contracted [4835]	$286	211%
Fairos/Occunet Contracted [4837]	$299	221%

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 $59.
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 Blount Memorial Hospital 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.