Office visit, established patient (30-39 min)
Facility: Children'S Mercy South
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $194
- Cash Discount Price: $144
- vs. Medicare Baseline: 1.43x 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 | $76 - $288 | 56% |
| Healthy Blue | $81 - $133 | 60% |
| Medicaid / KanCare | $81 - $193 | 60% |
| Healthlink | $95 - $378 | 70% |
| Quiktrip | $96 - $279 | 71% |
| Blue Cross Blue Shield | $106 - $317 | 78% |
| Wppa Providrs Care | $122 - $279 | 90% |
| Aetna | $122 - $292 | 90% |
| Multiplan | $122 - $326 | 90% |
| Health Midwest Comprehensive Care | $130 - $279 | 96% |
| Home State Health | $133 | 98% |
| American Healthcare Alliance | $137 - $365 | 101% |
| Medica | $140 - $250 | 103% |
| Humana | $143 - $285 | 105% |
| Orscheln | $144 - $279 | 106% |
| Nebraska Furniture Mart | $147 - $279 | 108% |
| Cigna | $148 - $250 | 109% |
| Coventry Health Care Of Kansas | $155 - $317 | 114% |
| Mercy Health | $176 - $322 | 130% |
| Coxhealth Network | $178 - $317 | 131% |
| Wellfit/Centrus | $180 - $279 | 133% |
| Centivo | $185 - $279 | 136% |
| National Preferred Provider Network | $212 - $386 | 156% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the facility's cash median rate is $144.00, which is significantly lower than the gross charge of $300.00. This cash price is notably higher than the Medicare benchmark of $135.60, suggesting that for patients with high-deductible plans or those paying out-of-pocket, the cash rate may represent a more predictable cost than relying on insurance negotiations where the allowed amount could exceed the cash price. While the facility is located in Overland Park, KS, and operates as a voluntary non-profit, specific county or state average data was not provided in this report, so comparisons are limited to the federal Medicare baseline.
Insurance payers negotiate rates that generally exceed the cash price due to administrative costs and contract structures; for instance, UnitedHealthcare's range spans from $76 to $288, while Blue Cross Blue Shield's range extends from $106 to $317 across 37 plans. Patients should verify their specific plan's negotiated rate before scheduling, as assuming in-network coverage guarantees the lowest price can be misleading, with some in-network rates reaching up to $386. To minimize costs, consumers are encouraged to ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront, and to request an itemized bill to ensure no unbundled codes or services not rendered are included in the final invoice.