Office visit, established patient (30-39 min)
Facility: Stormont Vail Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $152
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.12x 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 | $118 - $189 | 87% |
Consumer Guidance & Cost Commentary
For this CPT code representing an office visit with an established patient, the facility's negotiated rate is $152.00, which is significantly lower than the median paid amount of $43,535.00 reported for this service. While the facility is located in Topeka, Kansas, and is a voluntary non-profit acute care hospital, the data indicates a single payer with a negotiated range between $118 and $189. It is important to note that cash-pay rates are not available for this specific service, meaning patients with high-deductible plans should not assume paying out-of-pocket will result in lower costs. Instead, patients should verify their specific plan's allowed amount, as commercial negotiated rates often reflect the true cost of care delivery rather than the inflated chargemaster lists.
When reviewing your bill, be aware that summary invoices may obscure individual charges, so always request a full itemized statement to identify any unbundled codes or services not rendered. Although the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is crucial to ensure that ancillary services like labs or radiology were properly coordinated. If you receive a bill that seems excessive, dispute it in writing with the billing supervisor rather than accepting verbal assurances. Additionally, since cash discounts are not applicable here, focus on understanding your deductible status and the specific allowed amount for your insurance plan to avoid unexpected out-of-pocket expenses.