Office visit, established patient (30-39 min)
Facility: Lmh
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $478
- Cash Discount Price: $162
- vs. Medicare Baseline: 3.53x 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 353% of the Medicare baseline (a markup of 253%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $52 - $55 | 38% |
| Edw | $89 | 66% |
| Cigna | $335 - $899 | 247% |
| Aetna | $374 - $1,117 | 276% |
| UnitedHealthcare | $406 - $932 | 299% |
| Non Contracted | $469 - $1,076 | 346% |
| First Health | $545 - $1,251 | 402% |
Consumer Guidance & Cost Commentary
For this office visit service, the facility's cash price of $162.00 is significantly lower than the negotiated rates paid by most major insurers, such as Cigna ($335–$899) and Aetna ($374–$1,117). While the facility's cash rate is also well below the gross chargemaster of $647.00, it is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. If you have a high-deductible plan, paying the cash price upfront may result in immediate savings compared to your insurance allowing a higher negotiated amount, provided you have not yet met your deductible. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final balance before any insurance claim is processed.
This service is benchmarked against federal standards, where the Medicare allowed amount of $135.60 serves as the baseline for fair pricing. The commercial negotiated rates observed here generally align with the typical range of 200% to 300% of the Medicare rate, which is common in the healthcare market, though fair pricing is often defined as 120% to 150% of Medicare. While specific state or county average comparisons were not provided in the available data, the facility's location in Lawrence, KS (ZIP 66044) suggests these rates reflect local market dynamics. To avoid unexpected costs, patients should request an itemized bill to review every charge and dispute any errors, as over 80% of hospital bills contain inaccuracies that can be corrected through a formal written