CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Veterans Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $168
  • Cash Discount Price: $194
  • vs. Medicare Baseline: 1.24x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Veterans Memorial Hospital is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $194. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.24x the Medicare baseline. Located in 40 1St Street Se, Waukon, IA.
Cash / Self-Pay
$194

Average discount available for prompt cash payment at this facility.

Insurance Median
$168

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: $194 (143%)
Insurance Median: $168 (124%)
Cash: $194 (143% of Medicare)
Ins. Median: $168 (124% 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.

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
Quartz Comm - All Other Plans $65 - $293 48%
Amerigroup Mcaid - All Other Plans $80 - $291 59%
Humana $80 - $293 59%
Iowa Total Care Exchange $80 - $168 59%
Amerigroup Mcr Adv $125 - $168 92%
Iowa Total Care Mcr Adv $125 - $168 92%
Medica Mcr Adv $125 - $168 92%
Molina Mcr Adv $125 - $168 92%
Quartz Mcr Adv $125 - $168 92%
UnitedHealthcare $125 - $332 92%
Welmark Mcr Adv $125 - $168 92%
Iowa Total Care Mcaid - All Other Plans $148 - $291 109%
Molina Mcaid - All Other Plans $148 - $291 109%
Aetna $194 - $261 143%
Medica Comm - All Other Plans $231 170%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 40 1St Street Se, Waukon, IA 52172
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals