CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Northwestern Medicine McHenry

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $176
Cash Discount Price: $281
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Northwestern Medicine McHenry is $176. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $281. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.30x the Medicare baseline. Located in 4201 Medical Center Drive, McHenry, IL.

Cash / Self-Pay

$281

Average discount available for prompt cash payment at this facility.

Insurance Median

$176

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: $281 (207%)

Insurance Median: $176 (130%)

Cash: $281 (207% of Medicare)

Ins. Median: $176 (130% 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	$45 - $299	33%
Cigna	$46 - $427	34%
Mercy Care Health Plans [5013]	$71 - $173	52%
Blue Cross Blue Shield	$80 - $569	59%
UnitedHealthcare	$111 - $300	82%
Healthlink [125]	$118 - $284	87%
Choicecare [177]	$125 - $303	92%
Multiplan/Phcs [142]	$148 - $569	109%
The Alliance [1703]	$151 - $365	111%
Health'S Finest Network [126]	$164 - $415	121%
Beechstreet [176]	$188 - $455	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 $281.
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 Northwestern Medicine McHenry 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.