CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: North Austin Medical Center

Billing Code: 99214 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$210

about 1.5× the $136 Medicare rate · typically $101–$266

modeled estimate · not a bill or quote

What this hospital charges insurers

$356

Above the fair price

about $146 over the fair price · 2.6× Medicare

Medicare pays $136 Fair price $210 This hospital $356 Cash price $487 Hospital's list price $487

How we calculate the fair BaseRate →

How this hospital compares to other TX hospitals

Highest price of the 9 TX hospitals we have prices for — worth calling around.

Cheapest $48 Priciest $356

Black dot = this hospital, among the 9 TX hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (30-39 min) is about $210 (about 1.5× the $136 Medicare rate). North Austin Medical Center charges insurers about $356, or about $487 in cash — above the fair price. Located in Austin, TX.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $210. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$65 - $504	48%
Blue Cross Blue Shieldmajor	$78 - $460	58%
Aetnamajor	$94 - $627	69%
Cignamajor	$360 - $460	265%
Amerigroup	$41	30%
Health Net	$171 - $729	126%
Healthcare Highways	$77 - $336	57%
Moda Health	$62 - $415	46%
Oscar Health	$215 - $240	159%
+ 22 smaller / regional plans	$50 - $1,009

Government programs also on file: Medicaid.

Excludes 7 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 487), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99214.

Insurance Before you use insurance

Call your insurance company to confirm North Austin Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 99214.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at North Austin Medical Center

Compare: Office visit, established patient (30-39 min) at other TX hospitals

Insurance negotiated median for the same procedure, sorted lowest first.