Office visit, established patient (30-39 min)
Facility: Providence Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $122
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| Early Detection Works | $122 | 90% |
Consumer Guidance & Cost Commentary
For this office visit at Providence Medical Center in Kansas City, the insurance negotiated rate is $122, which is significantly lower than the facility's gross charge of $828. While the median amount paid by insurers is $248, the cash price is not listed, so patients should directly inquire about self-pay or prompt-pay discounts before scheduling. It is important to note that cash payments can sometimes be cheaper for individuals with high-deductible plans if the insurance negotiated rate exceeds the cash price, making upfront payment a viable option to reduce out-of-pocket costs.
This service is benchmarked against Medicare, where the allowed amount is $135.60, indicating that the negotiated rate of $122 is 90% of the Medicare standard. Patients should be aware that commercial rates often include administrative overhead that can inflate the baseline price, and comparing these rates to the Medicare benchmark provides a clearer picture of fair pricing than looking at the hospital's full list charges. If you receive a bill that appears higher than expected, you should request a detailed itemized statement to verify that all services were rendered and that no errors or unbundled codes were included.