CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: The Children's Mercy Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $194
Cash Discount Price: $144
vs. Medicare Baseline: 1.43x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at The Children's Mercy Hospital is $194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.43x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$194

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: $144 (106%)

Insurance Median: $194 (143%)

Cash: $144 (106% of Medicare)

Ins. Median: $194 (143% 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
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%
Aetna	$122 - $292	90%
Multiplan	$122 - $326	90%
Wppa Providrs Care	$122 - $279	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%

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 $144.
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 The Children's Mercy Hospital 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.