Office visit, established patient (30-39 min)
Facility: AHMC Seton Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $371
- Cash Discount Price: $429
- vs. Medicare Baseline: 2.74x 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 274% of the Medicare baseline (a markup of 174%). 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 |
|---|---|---|
| Medi-Cal | $30 | 22% |
| San Francisco Health Plan | $42 | 31% |
| Cmac | $43 | 32% |
| Hill Physicians Medical Group Inc | $43 - $127 | 32% |
| Kaiser | $43 - $551 | 32% |
| Blue Cross Blue Shield | $45 - $511 | 33% |
| San Mateo County/San Mateo County General Hospital | $46 | 34% |
| Asian American Medical Group | $52 | 38% |
| North East Medical Services | $52 | 38% |
| Health Plan Of San Mateo Healthworx | $53 | 39% |
| Brown And Toland Medical Group | $54 | 40% |
| Jade Health Care Mg | $56 - $336 | 41% |
| Health Plan Of San Mateo | $60 | 44% |
| Self Pay | $68 - $229 | 50% |
| Athens Administrators | $90 | 66% |
| Corvel Healthcare | $90 | 66% |
| Multiplan/Bce Emergis | $90 - $504 | 66% |
| Work Comp Other | $90 | 66% |
| Canopy Health | $136 - $202 | 100% |
| UnitedHealthcare | $213 - $385 | 157% |
| Chinese Community Health Plan | $227 - $403 | 167% |
| Brand New Day | $273 - $403 | 201% |
| Easy Choice Hospital Services | $273 - $403 | 201% |
| Interplan Corporation | $273 - $403 | 201% |
| Private Healthcare Sytems Inc | $341 - $504 | 251% |
| The First Health Network | $341 - $504 | 251% |
| Health Net | $349 - $516 | 257% |
| Beech Street Corporation | $364 - $538 | 268% |
| Healthcare Foundation Of San Mateo | $364 - $538 | 268% |
| Tricare | $364 - $538 | 268% |
| Choicecare Network | $387 - $571 | 285% |
| Multiplan | $387 - $571 | 285% |
| Mills Peninsula Health Services | $409 - $605 | 302% |
| Indemnity | $455 - $672 | 336% |
| Workers Compensation Federal | $455 - $672 | 336% |