Office visit, established patient (30-39 min)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $166
- Cash Discount Price: $146
- vs. Medicare Baseline: 1.22x 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.
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 |
|---|---|---|
| Medicaid / KanCare | $44 - $151 | 32% |
| Medica Contracted [320239] | $64 - $111 | 47% |
| Kindful Hospice Contracted [320434] | $87 | 64% |
| Elara Caring Aspire Hospice [20433] | $87 | 64% |
| Cross Timbers Hospice [20098] | $87 | 64% |
| Blue Cross Blue Shield | $87 - $227 | 64% |
| Humana | $87 - $113 | 64% |
| Pace Of The Ozarks Contracted [320518] | $87 | 64% |
| Medicare (plans) | $87 - $88 | 64% |
| Halo Hcr Inc Hospice [20432] | $87 | 64% |
| Aetna | $87 - $259 | 64% |
| Mercy Hospice Okc [20252] | $87 | 64% |
| Kindful Hospice [20434] | $87 | 64% |
| Dept Of Veteran Affairs Contracted [320106] | $87 | 64% |
| Halo Hcr Inc Hospice Contracted [320432] | $87 | 64% |
| Tricare | $88 | 65% |
| UnitedHealthcare | $91 - $206 | 67% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $92 | 68% |
| United Medical Resources Contracted [320454] | $119 - $206 | 88% |
| Cigna | $121 - $235 | 89% |
| Workers Comp [20426] | $141 - $244 | 104% |
| Aither Health Contracted [320449] | $141 - $244 | 104% |
| Mercy Benefit Admin Contracted [320251] | $141 - $244 | 104% |
| Imagine 360 Contracted [320494] | $141 - $244 | 104% |
| Yuzu Health Contracted [320521] | $141 - $244 | 104% |
| Healthlink Contracted [320179] | $141 - $244 | 104% |
| American Healthcare Alliance Contracted [320020] | $141 - $244 | 104% |
| Ebms Contracted [320493] | $141 - $244 | 104% |
| Edison Health Solutions Contracted [320502] | $141 - $244 | 104% |
| Auxiant Contracted [320462] | $141 - $244 | 104% |
| Reflect Health Contracted [320492] | $141 - $244 | 104% |
| First Health Contracted [320128] | $150 - $259 | 111% |
| Ambetter / Centene | $151 | 111% |
| Home State Health Plan Contracted [320187] | $151 | 111% |
| Providrs Care Network Contracted [320484] | $169 | 125% |
| Health Choice Contracted [320166] | $197 | 145% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, Mercy Hospital Pittsburg, Inc. lists a gross charge of $225.00. While the facility offers a cash median price of $146.00, which is lower than the state average of $145.00, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. For instance, Aetna and UnitedHealthcare have negotiated ranges starting at $87 and extending up to $206, while Workers Comp and various contracted entities have rates reaching $244. This illustrates that relying solely on the gross charge can be misleading; the actual cost depends heavily on whether you are paying out-of-pocket or using an insurance plan with specific contract terms.
To minimize unexpected costs, it is advisable to verify if your specific insurance plan has a lower negotiated rate than the cash price, as paying cash upfront may result in a lower total out-of-pocket expense if your deductible is not yet met. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid in full before or shortly after the service. If you receive a bill from an out-of-network provider, such as certain hospice contractors or ancillary services, you may be subject to balance billing for the difference between the allowed amount and the full charge. In such cases, you should request an itemized audit to identify any unbundled codes or services not rendered, and consider disputing the balance bill under