CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Pine Rest Christian Mental Health Services

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $105
Cash Discount Price: $139
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Pine Rest Christian Mental Health Services is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.77x the Medicare baseline. Located in 300 - 68Th Street, Se, Grand Rapids, MI.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $139 (103%)

Insurance Median: $105 (77%)

Cash: $139 (103% of Medicare)

Ins. Median: $105 (77% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$37 - $82	27%
Golden Rule [1131]	$46 - $106	34%
Healthscope Benefits [1140]	$46 - $106	34%
Ubh [1167]	$46 - $106	34%
UnitedHealthcare	$46 - $106	34%
Aetna	$62 - $192	46%
Blue Cross Blue Shield	$62 - $129	46%
Champva [1117]	$80 - $124	59%
Humana	$80 - $144	59%
Medicare (plans)	$80 - $124	59%
Molina [1156]	$80 - $124	59%
Tricare	$80 - $124	59%
Veterans Administration [1174]	$80 - $124	59%
Behavioral Health Systems [1115]	$92 - $109	68%
Beacon/Carelon Behavioral Health [1198]	$101 - $121	74%
Blue Care Network [1000]	$106 - $125	78%
Asr Physicians Care Health Plan [1160]	$113 - $133	83%
Hap Ppo/Health Alliance Plan [1134]	$113 - $133	83%
Mclaren Health Plan [1149]	$113	83%
University Of Michigan Health Plan Comm [1159]	$119 - $140	88%
University Of Michigan Health Plan [1205]	$119 - $140	88%
Ambetter / Centene	$120	88%
Manistee Benzie County Cmh [3526]	$129	95%
Priority Health [1300]	$141	104%
Network 180 [3530]	$145	107%
Compsych [1122]	$155 - $209	114%
Cofinity [1120]	$163 - $192	120%
Geha [1129]	$163 - $192	120%
Meritain Health Plan [1153]	$163 - $192	120%
Cigna	$170	125%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $139.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pine Rest Christian Mental Health Services is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.