Office visit, established patient (30-39 min)
Facility: Salina Regional Health Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $175
- Cash Discount Price: $268
- vs. Medicare Baseline: 1.29x 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 |
|---|---|---|
| Blue Cross Blue Shield | $85 - $89 | 63% |
| Preferred Phsic | $117 - $342 | 86% |
| Preferred Healthcare - All Other Plans | $158 - $462 | 117% |
| Multiplan (Mpi)-All Plans | $175 - $513 | 129% |
| Aetna | $175 - $513 | 129% |
| Cigna | $175 - $513 | 129% |
| Providers Care (Wppa)-All Plans | $175 - $513 | 129% |
Consumer Guidance & Cost Commentary
For this office visit at Salina Regional Health Center in Salina, KS, the cash price of $268.00 is notably lower than the facility's negotiated rates, which range from $175.00 to $513.00 depending on the insurance plan. While the facility's cash rate is higher than the state average for this service, it remains significantly below the gross charges listed on the hospital's chargemaster. Patients with high-deductible plans or those without insurance may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated amounts paid by insurers often exceed the cash rate. To secure the lowest possible price, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
The facility's allowed amount under Medicare is $135.60, which serves as a critical benchmark for evaluating commercial pricing. Commercial negotiated rates for this procedure average 1.3 times the Medicare amount, reflecting the administrative costs and contract structures inherent in private insurance. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still request an itemized bill to verify that all charges are accurate and that no unbundled codes or services not rendered have been included. If a balance bill is received unexpectedly, patients should dispute it in writing with the insurer rather than paying immediately, and they should avoid signing consent waivers that waive their rights to these protections.