Office visit, established patient (30-39 min)
Facility: St Luke Hospital & Living Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $74
- Cash Discount Price: Unavailable
- 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 |
|---|---|---|
| Va Ccn | $28 - $197 | 21% |
| Blue Cross Blue Shield | $28 - $197 | 21% |
| Ambetter / Centene | $28 - $199 | 21% |
| UnitedHealthcare | $28 - $197 | 21% |
| Bluestem Pace | $28 - $197 | 21% |
| Humana | $28 - $197 | 21% |
| Kansas Department Of Health And Environment | $28 - $197 | 21% |
Consumer Guidance & Cost Commentary
For this office visit to an established patient lasting 30 to 39 minutes, the facility's gross charge is $145.00, while the Medicare benchmark amount is $135.60. The negotiated rates paid by various insurance carriers, including Blue Cross Blue Shield and Humana, range from $28.00 to $199.00 depending on the specific plan. It is important to note that while these negotiated rates serve as a ceiling for in-network members, they often exceed the actual cash price. For patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly can sometimes result in lower total costs than using insurance, provided the facility offers a self-pay or prompt-pay discount.
The facility is a Critical Access Hospital in Marion, Kansas, and the data indicates that cash and negotiated rates are not explicitly listed in the provided summary for this specific service. However, patients should be aware that commercial negotiated rates frequently include administrative overhead, which can inflate the baseline price by 20% to 40% compared to the true cost of care. To ensure you are receiving the best possible price, it is recommended to contact the hospital directly to confirm if self-pay discounts or prompt-pay incentives are available before scheduling your appointment. Always request a waiver of insurance submission if you intend to pay out-of-pocket to avoid automatic claims processing, which could void any cash discounts.