Vaginal delivery (full package)
Facility: Clay County Medical Center
Billing Code: 59400 (CPT)
- CPT Billing Code: 59400
- Insurance Median: $3,662
- Cash Discount Price: $3,938
- vs. Medicare Baseline: 1.65x 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 $2,214.42 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 |
|---|---|---|
| UnitedHealthcare | $1,876 - $3,741 | 85% |
| Multiplan- All Plans | $1,895 - $3,741 | 86% |
| Wppa/Providrs Care- All Plans | $2,593 - $3,662 | 117% |
| Aetna | $3,662 | 165% |
| Health Partners - All Plans | $3,741 | 169% |
Consumer Guidance & Cost Commentary
For CPT code 59400, representing a vaginal delivery (full package) at Clay County Medical Center in Clay Center, KS, the cash median price is $3,938.00, which matches the facility's gross charge. This rate is significantly higher than the state average, reflecting a markup of 1.7 times the Medicare benchmark of $2,214.42. While commercial payers like UnitedHealthcare and Multiplan have negotiated rates ranging from $1,876 to $3,741, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that while the facility is a Critical Access Hospital with a government-local ownership structure, patients should verify their specific plan's allowed amount, as some in-network contracts may result in higher out-of-pocket costs than direct cash payment.
To ensure you are not overcharged, you should request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill from an out-of-network provider, the No Surprises Act may protect you from balance billing for emergency care or non-emergency services at an in-network facility. Additionally, ask the hospital about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. Always confirm whether your specific situation qualifies for these discounts and ensure you have a written record of any dispute regarding billing errors to protect your financial interests.