Office visit, established patient (30-39 min)
Facility: Saint John Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $151
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.11x 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 |
|---|---|---|
| Blue Cross Blue Shield | $90 - $189 | 66% |
| Early Detection Works | $122 | 90% |
Consumer Guidance & Cost Commentary
For this office visit at Saint John Hospital in Leavenworth, KS, the Medicare benchmark rate of $135.60 serves as the objective baseline for evaluating pricing. While the facility's negotiated rate with Early Detection Works is $151.00, this figure is significantly higher than the Medicare amount, reflecting the standard administrative markup inherent in commercial contracts. It is important to note that the facility's cash median is not listed, but patients with high-deductible plans should consider that paying cash upfront might be more cost-effective if the negotiated insurance rate exceeds the cash price. Additionally, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full before or shortly after the service, bypassing costly insurance billing cycles.
The data indicates that for this specific CPT code, the lowest negotiated rate among payers is $90, while the highest is $189 across three Blue Cross Blue Shield plans. Although the provided dataset does not include explicit state or county average comparisons for this specific code, the Medicare rate of $135.60 remains the scientifically validated cost baseline used to determine fair pricing. Patients should be aware that commercial rates often average 200% to 300% of Medicare, whereas fair pricing is typically defined as 120% to 150% of the Medicare amount. To ensure transparency, consumers should request an itemized bill to verify that charges align with these benchmarks and to identify any potential errors, as over 80% of hospital bills contain discrepancies.