Office visit, established patient (30-39 min)
Facility: Clay County Medical Center
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $132
- Cash Discount Price: $142
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $68 - $186 | 50% |
| Wppa/Providrs Care- All Plans | $68 - $186 | 50% |
| Health Partners - All Plans | $70 - $190 | 52% |
| UnitedHealthcare | $70 - $190 | 52% |
| Multiplan- All Plans | $70 - $190 | 52% |
Consumer Guidance & Cost Commentary
For this office visit at Clay County Medical Center in Clay Center, Kansas, the cash price is $142.00, which matches the facility's cash median. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates for this service range from $68 to $190 across five major payers, including Aetna, UnitedHealthcare, and Health Partners. It is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures; therefore, patients with high-deductible plans may find paying the full cash price of $142.00 more affordable than having their insurance cover a negotiated amount that could be significantly higher.
To ensure you are not overcharged, always verify the specific "self-pay" or "prompt-pay" discount offered by the hospital before scheduling, as these upfront payments can reduce the total cost. If you do receive a bill, request a detailed itemized statement to review every code and charge, as over 80% of hospital bills contain errors such as unbundled services or items not rendered. Additionally, remember that the No Surprises Act protects you from balance billing for out-of-network providers at in-network facilities, so if you encounter a surprise bill, you have the right to dispute it with your insurer rather than paying immediately.