Office visit, established patient (30-39 min)
Facility: Wesley Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $300
- Cash Discount Price: $1,001
- vs. Medicare Baseline: 2.21x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 221% of the Medicare baseline (a markup of 121%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $66 | 49% |
| United | $151 - $450 | 111% |
| Health Partners Of Kansas | $173 - $500 | 128% |
| Aetna | $174 - $357 | 128% |
| Medical Associates Health Plan | $189 | 139% |
| Preferred Health Choices | $189 | 139% |
| Spirit Aerosystems | $320 | 236% |
| First Health | $461 | 340% |
| Triwest Healthcare Alliance | $651 | 480% |
| Multiplan | $701 - $901 | 517% |
| Usa Managed Care | $851 | 628% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the cash price at Wesley Medical Center in Wichita, KS, is $1,001. This cash rate is significantly higher than the facility's negotiated rates, which range from $66 to $901 depending on the insurance carrier. While the facility's negotiated rates are generally lower than the gross charge, they often remain above the Medicare benchmark of $135.60, which serves as the objective baseline for fair pricing. In this specific case, the cash price is approximately 2.2 times the Medicare amount, indicating a substantial markup relative to the federal standard. Patients should note that while insurance contracts cap charges, the administrative costs and contract dynamics often result in negotiated rates that exceed what a self-pay patient would pay upfront.
To minimize costs, patients should verify whether their specific insurance plan qualifies for the lowest negotiated rates available, which in this dataset range from $66 for Blue Cross Blue Shield to $901 for Multiplan. However, if a patient has a high deductible or no coverage, paying the cash price of $1,001 may be more economical than the insurance negotiated rate, especially if the deductible has not yet been met. Before scheduling, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, patients should request an itemized bill to ensure no errors exist, as over 80% of hospital bills contain discrepancies that can be corrected through a formal audit.