Office visit, established patient (30-39 min)
Facility: Susan B Allen Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $554
- Cash Discount Price: $105
- vs. Medicare Baseline: 4.09x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 409% of the Medicare baseline (a markup of 309%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $350 | 258% |
| Providrs Care | $757 | 558% |
Consumer Guidance & Cost Commentary
For this office visit at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price is $105.00, which is significantly lower than the facility's gross charge of $162.00. While the hospital's negotiated rates with UnitedHealthcare and Providrs Care are $350.00 and $757.00 respectively, these amounts are often higher than the cash price due to administrative costs and contract structures. If you have a high-deductible plan, paying the $105.00 cash rate upfront may be more cost-effective than your insurance covering the higher negotiated amount, especially if your deductible has not yet been met.
To ensure you are not overcharged, it is important to understand that commercial rates are frequently benchmarked against Medicare. In this case, the Medicare amount for this service is $135.60, meaning the cash price of $105.00 is actually below the federal baseline, whereas the negotiated rates exceed it. If you receive a bill that appears to include balance billing for out-of-network services, remember that the No Surprises Act protects you from being billed for the difference between the provider's full charge and your insurance allowed amount for emergency or non-emergency care at in-network facilities. Always request a full itemized bill before paying, as summary bills can hide unbundled codes or services not rendered, and ask the hospital directly about any available self-pay or prompt-pay discounts to further reduce your out-of-pocket costs.