Office visit, established patient (30-39 min)
Facility: Wamego Health Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $75
- Cash Discount Price: $137
- vs. Medicare Baseline: 0.55x 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 | $66 - $72 | 49% |
| Medicaid / KanCare | $69 - $75 | 51% |
| Aetna | $69 - $75 | 51% |
| Tricare | $97 | 72% |
| Providrs Care | $116 | 86% |
| Blue Cross Blue Shield | $248 - $261 | 183% |
Consumer Guidance & Cost Commentary
For the CPT code 99214 representing an office visit with an established patient (30-39 minutes), the facility in Wamego, KS, has a cash median price of $137.00, which is notably lower than the negotiated rates paid by commercial payers. While the facility's negotiated rates range from $66 to $261 depending on the insurer, the cash price offers a significant alternative for patients without insurance or those with high-deductible plans. It is important to note that commercial negotiated rates often include administrative overhead and contract premiums, sometimes exceeding the cash price by a substantial margin. Patients should verify their specific plan's deductible status before assuming insurance will result in lower out-of-pocket costs, as paying cash upfront can sometimes be more economical if the insurance allowed amount is higher than the cash rate.
The Medicare benchmark for this service is $135.60, which serves as the objective baseline for evaluating pricing fairness. The facility's cash price of $137.00 is extremely close to this benchmark, indicating a rate structure that aligns with the federal government's cost-based reimbursement standards rather than inflated chargemaster lists. For commercial payers, the negotiated rates vary widely, with UnitedHealthcare and Medicaid/KanCare plans ranging between $66 and $75, while Blue Cross Blue Shield plans have a higher range of $248 to $261. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service. Additionally, requesting