Office visit, established patient (30-39 min)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $75
- Cash Discount Price: $122
- vs. Medicare Baseline: 0.55x 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 |
|---|---|---|
| UnitedHealthcare | $66 - $72 | 49% |
| Medicaid / KanCare | $69 - $75 | 51% |
| Aetna | $69 - $75 | 51% |
| Tricare | $97 | 72% |
| Providrs Care | $116 | 86% |
| Blue Cross Blue Shield | $204 - $215 | 150% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 30 to 39 minutes, the facility's cash median rate is $122.00, which is significantly lower than the negotiated rates paid by major insurers like Blue Cross Blue Shield ($204–$215) and Medicaid/KanCare ($69–$75). While the cash price appears attractive, patients with high-deductible plans should verify whether their insurance negotiated rate exceeds this amount, as paying out-of-pocket might result in higher out-of-pocket costs if the deductible has not yet been met. It is also important to note that the facility's cash rate is 0.6 times the Medicare benchmark of $135.60, suggesting the cash price is well below the federal cost baseline used to evaluate hospital pricing markups.
To minimize potential surprise costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative overhead of insurance billing cycles. If a balance bill arises from an out-of-network service, such as an emergency physician or lab at an in-network facility, the No Surprises Act generally protects patients from paying the difference between the provider's chargemaster and the insurance allowed amount. Furthermore, if a summary bill is received, consumers should request a full itemized audit to identify unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through formal written disputes sent to the billing supervisor.