Office visit, established patient (30-39 min)
Facility: Kansas Heart Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $72
- Cash Discount Price: $163
- vs. Medicare Baseline: 0.53x 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 |
|---|---|---|
| UnitedHealthcare | $50 - $119 | 37% |
| Tricare | $69 | 51% |
| Blue Cross Blue Shield | $72 - $112 | 53% |
| Medicaid / KanCare | $72 | 53% |
| Celtic Mcaid - All Other Plans | $72 | 53% |
| Soonerselect Mcaid - All Plans | $72 | 53% |
| Aetna | $97 | 72% |
| Wppa - All Plans | $122 | 90% |
| Multiplan - All Plans | $142 | 105% |
Consumer Guidance & Cost Commentary
For this office visit at Kansas Heart Hospital in Wichita, KS, the negotiated rates for CPT code 99214 range from $50 to $142 across nine different payers, with a median negotiated amount of $72. This is notably lower than the facility's gross charge of $259, demonstrating the impact of insurance contracts on final costs. However, the cash price of $163 exceeds the median negotiated rate, meaning patients with high-deductible plans or those without insurance may find paying out-of-pocket more expensive than using an in-network plan, unless they qualify for specific self-pay or prompt-pay discounts. It is important to verify your specific plan's allowed amount before scheduling, as some in-network carriers may allow amounts that differ significantly from the facility's standard negotiated rates.
The facility's pricing is benchmarked against Medicare, which sets a baseline of $135.60 for this service. While the cash price of $163 is higher than the Medicare amount, it remains below the gross charge, suggesting a moderate markup relative to the federal standard. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur for ancillary services like labs or emergency physicians if they are not covered by the facility's network agreements. To avoid surprise costs, consumers should request a full itemized bill before paying and dispute any charges that appear to include unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written audit.