CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Cass County Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $60
Cash Discount Price: $99
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Cass County Memorial Hospital is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.44x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $99 (73%)

Insurance Median: $60 (44%)

Cash: $99 (73% of Medicare)

Ins. Median: $60 (44% 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	$24 - $166	18%
Amerigroup Mcr Adv - All Other Plans	$24 - $59	18%
Tricare	$24 - $80	18%
Triwest - All Plans	$24 - $78	18%
UnitedHealthcare	$24 - $128	18%
Va Ccn - All Plans	$24 - $80	18%
American Hlth Mcr Adv - All Plans	$25 - $61	18%
Iowa Total Care Mcaid	$25 - $189	18%
Iowa Total Care Mcr	$25 - $60	18%
Medicaid / KanCare	$25 - $185	18%
Molina Mcaid - All Plans	$25 - $192	18%
Wellmark Mcr Adv	$25 - $60	18%
Iowa Total Care Comm - All Other Plans	$27 - $88	20%
Midlands Choice Medica Mcr	$28 - $37	21%
Midlands Choice New Bus	$38 - $150	28%
Midlands Choice Pho (Ppo) - All Other Plans	$52 - $150	38%
Multiplan - All Plans	$55 - $176	41%
Medica Mcr Adv	$59	44%
Medica Comm - All Other Plans	$124 - $165	91%
Wellmark Hmo	$137	101%
Wellmark Ppo - All Other Plans	$137	101%

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 $99.
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 Cass County Memorial 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.