Office visit, established patient (30-39 min)
Facility: Mcpherson Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $247
- Cash Discount Price: $208
- vs. Medicare Baseline: 1.82x 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 |
|---|---|---|
| Tricare | $71 | 52% |
| UnitedHealthcare | $72 - $580 | 53% |
| Medicaid / KanCare | $72 - $580 | 53% |
| Health Blue Mcaid - All Other Plans | $74 - $592 | 55% |
| Humana | $81 | 60% |
| Healthy Blue Mcr Adv | $81 | 60% |
| Blue Cross Blue Shield | $81 | 60% |
| Ambetter / Centene | $81 - $93 | 60% |
| Wellcare Mcr Adv - All Plans | $81 | 60% |
| Va Ccn - All Plans | $81 | 60% |
| Aetna | $97 - $580 | 72% |
| Multiplan - All Plans | $100 - $522 | 74% |
| Central Plains - All Plans | $156 - $435 | 115% |
| Medical Associates - All Plans | $156 - $435 | 115% |
| Wppa - All Plans | $192 - $406 | 142% |
| Cigna | $198 - $551 | 146% |
| Health Partners - All Plans | $198 - $551 | 146% |
| Christian Health Aid - All Plans | $219 - $464 | 162% |
| First Health - All Plans | $260 - $551 | 192% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, McPherson Hospital in Kansas lists a gross charge of $281.00. While the facility's cash median rate is $208.00, which is lower than the gross charge, patients should note that many insurance plans have negotiated rates significantly higher than this cash price. For instance, UnitedHealthcare and Medicaid/KanCare have negotiated ranges starting at $72, while Aetna's range extends up to $580. This disparity highlights that for patients with high-deductible plans, paying the cash price of $208.00 upfront may result in lower out-of-pocket costs compared to having insurance pay a negotiated rate that exceeds the cash amount. Additionally, the facility offers a prompt-pay discount for those who settle their bill in full, which can further reduce the final amount owed.
When evaluating the cost of this service, it is important to compare the facility's pricing against the Medicare benchmark, which serves as a scientifically validated baseline for healthcare delivery costs. The Medicare amount for this procedure is $135.60, and commercial negotiated rates typically average between 200% and 300% of this figure, though fair pricing is often defined as 120% to 150%. While the data provided does not include specific state or county average comparisons for this specific code, patients should be aware that balance billing can occur if they receive care from out-of-network providers, where the provider bills the difference between the chargemaster rate and the insurance allowed amount. To avoid unexpected costs, consumers are