CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: North Austin Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $231
  • Cash Discount Price: $487
  • vs. Medicare Baseline: 1.70x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at North Austin Medical Center is $231. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $487. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.70x the Medicare baseline. Located in 12221 Mopac Expressway North, Austin, TX.
Cash / Self-Pay
$487

Average discount available for prompt cash payment at this facility.

Insurance Median
$231

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: $487 (359%)
Insurance Median: $231 (170%)
Cash: $487 (359% of Medicare)
Ins. Median: $231 (170% 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.

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 Plan $24 - $191 18%
Amerigroup $41 30%
Imperial Insurance $50 - $213 37%
Moda $62 - $263 46%
United $65 - $504 48%
Covenant Management Systems $76 - $323 56%
Healthcare Highways $77 - $336 57%
Blue Cross Blue Shield $78 - $460 58%
Imo Med - Select Network $79 - $336 58%
Nomi Health $84 - $415 62%
Shared Health $92 - $392 68%
Aetna $94 - $627 69%
Moda Health $95 - $415 70%
Evry Health $97 - $413 72%
Texas Healthcare Foundation Heb $97 - $415 72%
Texas Workforce Commission $103 - $437 76%
Curative Administrators $105 - $448 77%
Harbor Health Team $105 - $448 77%
Averde Health $118 - $504 87%
Naphcare $118 - $504 87%
Seven Corners $118 - $504 87%
UnitedHealthcare $118 - $504 87%
Austin Fc $132 - $560 97%
Comanche County $132 - $560 97%
National Choicecare $132 - $560 97%
Healthsmart Preferred Care $145 - $897 107%
Independent Medical Systems $145 - $617 107%
Physicians Cooperative Of Texas $145 - $617 107%
Prime Health $158 - $673 117%
First Health $164 - $796 121%
Coastal Comp Health Networks $171 - $729 126%
National Health Care $171 - $729 126%
Texas Municipal League $184 - $785 136%
Medcorp Southwest $197 - $841 145%
Rockport Healthcare Group $210 - $1,009 155%
Oscar $215 - $240 159%
Bce Emergis Corporation $237 - $1,009 175%
Beech Street $237 - $1,009 175%
Medical Control Network Solutions $237 - $1,009 175%
Multiplan $237 - $1,009 175%
Cigna $360 - $460 265%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12221 Mopac Expressway North, Austin, TX 78758
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals