CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Hill Country Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $261
Cash Discount Price: $1,085
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Hill Country Memorial Hospital is $261. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,085. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.92x the Medicare baseline. Located in 1020 South State Highway 16, Fredericksburg, TX.

Cash / Self-Pay

$1,085

Average discount available for prompt cash payment at this facility.

Insurance Median

$261

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: $1,085 (800%)

Insurance Median: $261 (192%)

Cash: $1,085 (800% of Medicare)

Ins. Median: $261 (192% 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
Superior Health	$54	40%
Community First Health Plans	$130 - $293	96%
Blue Cross Blue Shield	$198 - $320	146%
United	$267 - $488	197%
Healthcare Highways	$334	246%
Superior	$401	296%
Curative Administrators	$434	320%
First Health	$478	353%
Healthsmart Preferred Care	$597	440%
Multiplan	$814 - $922	600%
Triwest Health Alliance	$814	600%

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 $1,085.
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 Hill Country 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.