Office visit, established patient (30-39 min)
Facility: Saint Luke'S South Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $134
- Cash Discount Price: $179
- vs. Medicare Baseline: 0.99x 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 | $44 - $95 | 32% |
| Transplants-Case Rates [5750] | $104 - $298 | 77% |
| Cigna | $109 - $209 | 80% |
| Medicaid / KanCare | $110 - $165 | 81% |
| Blue Cross Blue Shield | $134 - $198 | 99% |
| Aetna | $163 - $283 | 120% |
| First Health [5512] | $177 | 131% |
| Commercial-Contracted [8000] | $224 | 165% |
Consumer Guidance & Cost Commentary
For CPT code 99214, an office visit for an established patient lasting 30 to 39 minutes, Saint Luke's South Hospital in Overland Park, KS, has a gross charge of $298.00. While the facility's cash median rate is $179.00, which is lower than the gross charge, the negotiated rates paid by major payers like UnitedHealthcare and Aetna range from $44 to $283. It is important to note that cash-pay can sometimes be the most economical option for patients with high-deductible plans, as the cash price of $179.00 is significantly lower than the average negotiated rates for many commercial insurers. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can often reduce the final bill by 20% to 50% by bypassing costly insurance claims processing.
This facility's pricing is benchmarked against the Medicare rate of $135.60, which serves as a scientifically validated baseline for the true cost of care. The facility's cash rate of $179.00 represents a markup of approximately 31% over the Medicare amount, while the median negotiated rate of $134.00 is roughly 100% of the Medicare rate, indicating that some insurance contracts may align closely with fair pricing standards. Given that over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, and verify their specific plan's deductible status before relying on insurance coverage to avoid unexpected balance billing