CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Monroe County Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $138
Cash Discount Price: $150
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Monroe County Hospital is $138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.02x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$138

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: $150 (111%)

Insurance Median: $138 (102%)

Cash: $150 (111% of Medicare)

Ins. Median: $138 (102% 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
Geha - All Plans	$80	59%
Tricare	$80	59%
Va Ccn - All Plans	$80	59%
UnitedHealthcare	$88	65%
Integrated Hp - All Plans	$117	86%
Multiplan - All Plans	$117	86%
Preferred Hlth - All Plans	$133	98%
Wellmark Hmo	$138	102%
Wellmark Ppo - All Other Plans	$138	102%
Centivo - All Plans	$141	104%
Midlands Choice - All Plans	$141	104%
Aetna	$235 - $250	173%
Iowa Total Care Mcaid - All Plans	$255	188%
Molina Mcaid - All Plans	$256	189%
Amerigroup Mcaid - All Other Plans	$262	193%

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 $150.
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 Monroe County Hospital 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.