Office visit, established patient (30-39 min)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $161
- Cash Discount Price: $153
- vs. Medicare Baseline: 1.19x 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 |
|---|---|---|
| Blue Cross Blue Shield | $56 - $89 | 41% |
| Aetna | $83 - $120 | 61% |
| Medica Contracted [320239] | $84 - $87 | 62% |
| UnitedHealthcare | $89 - $222 | 66% |
| Halo Hcr Inc Hospice Contracted [320432] | $89 | 66% |
| Cigna | $89 - $185 | 66% |
| Halo Hcr Inc Hospice [20432] | $89 | 66% |
| Cross Timbers Hospice [20098] | $89 | 66% |
| Elara Caring Aspire Hospice [20433] | $89 | 66% |
| Globalhealth Contracted [320145] | $89 | 66% |
| Mercy Mgd Behavioral Health Contracted [320259] | $89 | 66% |
| Medicaid / KanCare | $89 - $113 | 66% |
| Medical Associates Health Contracted [320444] | $89 | 66% |
| Kindful Hospice Contracted [320434] | $89 | 66% |
| Medicare (plans) | $89 | 66% |
| Pace Of The Ozarks Contracted [320518] | $89 | 66% |
| Dept Of Veteran Affairs Contracted [320106] | $89 | 66% |
| Tricare | $89 | 66% |
| Kindful Hospice [20434] | $89 | 66% |
| Cherokee Nation Health Serv Contracted [320066] | $89 | 66% |
| Mercy Hospice Okc [20252] | $89 | 66% |
| Humana | $89 - $113 | 66% |
| Qual Choice Contracted [320325] | $89 | 66% |
| Provider Partners Health Plans Contracted [320450] | $97 | 72% |
| First Health Contracted [320128] | $115 - $120 | 85% |
| Point C Contracted [320238] | $115 - $180 | 85% |
| Mercy Benefit Admin Contracted [320251] | $138 - $168 | 102% |
| United Medical Resources Contracted [320454] | $138 - $180 | 102% |
| Show-Me Health Administrators Contracted [320483] | $138 - $144 | 102% |
| Centivo Contracted [320505] | $147 | 108% |
| Edison Health Solutions Contracted [320502] | $161 - $168 | 119% |
| Auxiant Contracted [320462] | $161 - $180 | 119% |
| Ebms Contracted [320493] | $161 - $168 | 119% |
| Yuzu Health Contracted [320521] | $161 - $168 | 119% |
| Imagine 360 Contracted [320494] | $161 - $168 | 119% |
| American Healthcare Alliance Contracted [320020] | $161 - $168 | 119% |
| Reflect Health Contracted [320492] | $161 - $168 | 119% |
| Aither Health Contracted [320449] | $161 - $168 | 119% |
| Providrs Care Network Contracted [320484] | $169 | 125% |
| Federal Medical Center Contracted [320127] | $172 - $180 | 127% |
| Health Systems Inc Contracted [320174] | $172 - $180 | 127% |
| Preferred Health Plan Contracted [320522] | $172 - $180 | 127% |
| Healthscope Contracted [320182] | $172 - $180 | 127% |
| Insurance System Inc Contracted [320465] | $172 - $180 | 127% |
| Healthlink Contracted [320179] | $172 - $180 | 127% |
| Benefit Management Contracted [320052] | $172 - $180 | 127% |
| Compcare Of The Ozarks Contracted [320437] | $182 - $190 | 134% |
| Workers Comp [20426] | $184 - $192 | 136% |
| Private Health Care Systems Contracted [320320] | $213 - $222 | 157% |
| Multiplan Contracted [320270] | $218 - $228 | 161% |
| Multiplan [20270] | $218 - $228 | 161% |
Consumer Guidance & Cost Commentary
For CPT code 99214, an office visit for an established patient lasting 30 to 39 minutes, Mercy Specialty Hospital Southeast Kansas lists a gross charge of $235.00. This amount is significantly higher than the Medicare benchmark of $135.60, which serves as the federal baseline for the true cost of this service. While the facility's cash median price is $153.00, commercial insurance negotiated rates vary widely across 51 payers, ranging from $56 for Blue Cross Blue Shield to $228 for Multiplan. Because commercial contracts often include administrative overhead and volume-based pricing structures, the negotiated rates for many insurers exceed the cash price, meaning patients with high-deductible plans might pay less out-of-pocket by paying cash directly.
To minimize costs, patients should verify their specific plan's negotiated rate before scheduling, as some commercial payers like UnitedHealthcare and Point C have allowed amounts that far exceed the cash price. Additionally, patients are encouraged to ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative fees associated with insurance claims. Given that over 80% of hospital bills contain errors, consumers should request a detailed, itemized statement rather than accepting a summary bill, and dispute any discrepancies in writing to ensure they are only paying for services actually rendered.