Office visit, established patient (30-39 min)
Facility: Kansas Spine & Specialty Hospital, Llc
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $81
- Cash Discount Price: $138
- vs. Medicare Baseline: 0.60x 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 | $66 - $81 | 49% |
| Humana | $79 | 58% |
| UnitedHealthcare | $81 - $98 | 60% |
| United Mine Workers Of America | $81 | 60% |
| Aetna | $81 - $101 | 60% |
| Providrs Care Network | $81 | 60% |
| Lantern Specialty Care | $129 | 95% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, the Kansas Spine & Specialty Hospital, Llc lists a gross charge of $213.00. This facility is located in Wichita, KS, and its cash median price is $138.00. While the data does not provide a specific county average for comparison, the facility's cash rate is notably lower than its negotiated rates with major payers such as UnitedHealthcare, Aetna, and United Mine Workers Of America, which range from $81.00 to $101.00. Patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount, though they should verify their specific plan's allowed amount before scheduling.
It is important to note that the facility's cash median of $138.00 is higher than the Medicare benchmark amount of $135.60. Under federal protections like the No Surprises Act, patients are generally shielded from balance billing for out-of-network services at in-network facilities, but they should still request a prompt-pay discount if paying out-of-pocket. To ensure transparency, patients should ask the billing department for a self-pay or prompt-pay rate before check-in and insist on an itemized bill to review specific CPT codes, as summary bills can sometimes obscure unbundled charges or services not rendered.