CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $190
Cash Discount Price: $156
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Iowa Specialty Hospital - Clarion is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.40x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$190

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $156 (115%)

Insurance Median: $190 (140%)

Cash: $156 (115% of Medicare)

Ins. Median: $190 (140% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$76 - $525	56%
Tricare	$80 - $192	59%
Triwest Va - All Plans	$80 - $192	59%
UnitedHealthcare	$112 - $587	83%
Cigna	$120 - $599	88%
Midlands Choice-All Plans	$120 - $599	88%
Wellmark Hmo	$124	91%
Wellmark Ppo - All Other Plans	$124	91%
Healthscope Stellar-All Plans	$133 - $326	98%
Health Partners Ish-All Other Plans	$137 - $494	101%
Auxiant Clarion Schools-All Plans	$164 - $402	121%
Health Partners Prestage	$189 - $464	139%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $156.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Iowa Specialty Hospital - Clarion is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.