Office visit, established patient (30-39 min)
Facility: Wilson Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $194
- Cash Discount Price: $191
- vs. Medicare Baseline: 1.43x 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 | $38 - $579 | 28% |
| UnitedHealthcare | $72 - $538 | 53% |
| Ambetter / Centene | $72 - $579 | 53% |
| Aetna | $72 - $579 | 53% |
| Tricare | $89 - $307 | 66% |
| Cigna | $100 - $463 | 74% |
| Mulitplan-All Plans | $115 - $533 | 85% |
| Health Partners-All Plans | $115 - $533 | 85% |
| Humana | $142 - $307 | 105% |
Consumer Guidance & Cost Commentary
For CPT code 99214, representing an office visit with an established patient lasting 30 to 39 minutes, Wilson Medical Center in Neodesha, KS, lists a gross charge of $255.00. While the facility's cash median rate is $191.00, which is lower than the negotiated rates paid by major insurers like UnitedHealthcare ($72 to $538) and Aetna ($72 to $579), patients should be aware that commercial insurance often results in higher out-of-pocket costs due to administrative fees and contract structures. The facility's negotiated rate of $194.00 is slightly higher than its cash price, illustrating that paying out-of-pocket can sometimes be more economical than relying on insurance, particularly for those with high-deductible plans. Additionally, the facility is a Critical Access Hospital owned by the local government, and while the data does not provide specific county or state average comparisons for this specific code, patients are encouraged to verify if their specific insurance plan has a lower allowed amount before scheduling.
To minimize unexpected costs, patients should proactively request a "prompt-pay" discount, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the costly insurance claims process. It is also critical to avoid balance billing by ensuring the provider is in-network or by utilizing the No Surprises Act protections if care is received at an in-network facility from an out-of-network provider. If a bill is received, consumers should demand an itemized audit rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes