Office visit, established patient (30-39 min)
Facility: Kansas City Orthopaedic Institute
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $300
- Cash Discount Price: Unavailable
- 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 |
|---|---|---|
| Cigna | $193 | 142% |
| Blue Cross Blue Shield | $247 - $300 | 182% |
| UnitedHealthcare | $263 | 194% |
| Medica | $340 | 251% |
Consumer Guidance & Cost Commentary
For this office visit at Kansas City Orthopaedic Institute in Leawood, KS, the Medicare benchmark rate is $135.60, which serves as the objective baseline for evaluating pricing markups. While the facility's negotiated rates range from $193 to $340 depending on the insurance carrier, these figures are significantly higher than the Medicare amount, reflecting standard commercial pricing structures where administrative costs and contract dynamics often inflate the baseline price by 20% to 40%. It is important to note that cash-pay options are not listed for this service, meaning patients with high-deductible plans may not achieve savings by paying out-of-pocket, as the negotiated rates for in-network payers like Cigna and UnitedHealthcare exceed the cash price.
Patients should verify their specific plan details before scheduling, as insurance companies negotiate different maximum rates that can vary widely even within the same network. For instance, while Blue Cross Blue Shield has six plans paying between $247 and $300, Medica's single plan covers $340, illustrating how network tiering and contract dynamics affect final costs. If you have a high-deductible plan, you should check your deductible status before using insurance, as you may be responsible for the full negotiated amount if you haven't met your threshold. Additionally, since this is an Acute Care Hospital, you should ask the billing department about any "self-pay" or "prompt-pay" discounts that might apply if you choose to settle the bill upfront, as these incentives can bypass the costly claims processing cycle that typically inflates commercial rates.