Office visit, established patient (30-39 min)
Facility: Mercy Hospital Columbus
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $192
- Cash Discount Price: $153
- vs. Medicare Baseline: 1.42x 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 |
|---|---|---|
| Medicaid / KanCare | $59 - $171 | 44% |
| Medicare (plans) | $93 - $178 | 69% |
| Health Systems Inc Contracted [320174] | $101 | 74% |
| Insurance System Inc Contracted [320465] | $101 | 74% |
| Administrative Payor Contracted [320005] | $106 | 78% |
| Humana | $113 - $224 | 83% |
| Mercy Hospice Okc [20252] | $171 | 126% |
| Cross Timbers Hospice [20098] | $171 | 126% |
| Pace Of The Ozarks Contracted [320518] | $171 | 126% |
| Provider Partners Health Plans Contracted [320450] | $171 | 126% |
| Halo Hcr Inc Hospice Contracted [320432] | $171 | 126% |
| Aetna | $171 - $212 | 126% |
| Novasys Contracted [320285] | $171 | 126% |
| Dept Of Veteran Affairs Contracted [320106] | $171 | 126% |
| Indian Health Service Contracted [320198] | $171 | 126% |
| Blue Cross Blue Shield | $171 - $246 | 126% |
| Kindful Hospice Contracted [320434] | $171 | 126% |
| Centurion Of Missouri [20459] | $171 | 126% |
| Qual Choice Contracted [320325] | $171 | 126% |
| Halo Hcr Inc Hospice [20432] | $171 | 126% |
| Globalhealth Contracted [320145] | $171 | 126% |
| Cigna | $171 | 126% |
| Mercy Mgd Behavioral Health Contracted [320259] | $171 | 126% |
| UnitedHealthcare | $171 - $196 | 126% |
| Kindful Hospice [20434] | $171 | 126% |
| Medical Associates Health Contracted [320444] | $171 | 126% |
| Home State Health Plan Contracted [320187] | $171 | 126% |
| Ambetter / Centene | $171 | 126% |
| Cherokee Nation Health Serv Contracted [320066] | $171 | 126% |
| Elara Caring Aspire Hospice [20433] | $171 | 126% |
| Tricare | $172 | 127% |
| Healthscope Contracted [320182] | $182 | 134% |
| Workers Comp [20426] | $189 - $201 | 139% |
| United Medical Resources Contracted [320454] | $196 - $224 | 145% |
| Medica Contracted [320239] | $211 | 156% |
| Usa Managed Care Org Contracted [320429] | $212 | 156% |
| Healthlink Contracted [320179] | $212 - $224 | 156% |
| Mercy Benefit Admin Contracted [320251] | $212 - $224 | 156% |
| Federal Medical Center Contracted [320127] | $212 | 156% |
| Preferred Health Plan Contracted [320522] | $212 | 156% |
| First Health Contracted [320128] | $212 | 156% |
| American Healthcare Alliance Contracted [320020] | $212 | 156% |
| Auxiant Contracted [320462] | $224 | 165% |
| Reflect Health Contracted [320492] | $224 | 165% |
| Ppo Plus Contracted [320310] | $224 | 165% |
| 90 Degree Benefits Contracted [320436] | $224 | 165% |
| Private Health Care Systems Contracted [320320] | $224 | 165% |
| Show-Me Health Administrators Contracted [320483] | $224 | 165% |
| Yuzu Health Contracted [320521] | $224 | 165% |
| Point C Contracted [320238] | $224 | 165% |
| Imagine 360 Contracted [320494] | $224 | 165% |
| Benefit Management Contracted [320052] | $224 | 165% |
| Edison Health Solutions Contracted [320502] | $224 | 165% |
| Ebms Contracted [320493] | $224 | 165% |
| Aither Health Contracted [320449] | $224 | 165% |
Consumer Guidance & Cost Commentary
For the CPT code 99214 representing an office visit with an established patient (30-39 minutes), Mercy Hospital Columbus lists a gross charge of $236.00, which is 1.4 times the Medicare benchmark rate of $135.60. While the facility's median negotiated rate across 56 payers is $192.00, the cash-pay median is significantly lower at $153.00. This price difference highlights the potential savings for patients with high-deductible plans or those without insurance, as paying cash directly can be cheaper than the insurance negotiated rate. Patients should verify if their specific plan falls into the lowest tier of the 56 payers listed, which ranges from $59 to $246, and inquire about self-pay or prompt-pay discounts before scheduling to avoid unexpected costs.
To ensure you are receiving the most accurate billing, it is crucial to request an itemized bill that breaks down every service, code, and supply rather than accepting a summary invoice that obscures individual charges. Since over 80% of hospital bills contain errors such as unbundled codes or services not rendered, a line-by-line review is the most effective way to identify and dispute mistakes. Additionally, while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients should still review their itemized statement to confirm that all services were rendered and that no unauthorized charges were applied.