Office visit, established patient (30-39 min)
Facility: Golden Valley Memorial Hospital
Billing Code: 99214 (CPT)
- CPT Billing Code: 99214
- Insurance Median: $99
- Cash Discount Price: $75
- vs. Medicare Baseline: 0.73x 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 | $90 | 66% |
| Humana | $90 | 66% |
| UnitedHealthcare | $90 - $2,910 | 66% |
| Ambetter / Centene | $108 | 80% |
| Home State Health | $3,080 | 2271% |
Consumer Guidance & Cost Commentary
Golden Valley Memorial Hospital, located at 1600 N 2Nd St in Clinton, Missouri, offers a CPT code 99214 for an office visit with an established patient lasting 30 to 39 minutes. The facility's cash median rate is $75, while the median negotiated rate across five payers is $99. It is important to note that the cash price of $75 is lower than the median negotiated rate of $99, which may be advantageous for patients with high deductibles or those who can arrange payment upfront. Additionally, the facility's cash rate of $75 is significantly below the Medicare amount of $135.60, illustrating that commercial insurance contracts often result in higher out-of-pocket costs for patients compared to self-pay options.
For comparison, the facility's cash rate of $75 is lower than the state of Missouri average, which is approximately $100. The facility operates as an Acute Care Hospital owned by a Government - Hospital District or Authority and maintains a rating of 3. When comparing commercial rates to the Medicare benchmark, the facility's cash price is roughly 55% of the Medicare amount, whereas the median negotiated rate represents about 73% of the Medicare amount. Patients should verify if their specific insurance plan, such as Aetna, Humana, UnitedHealthcare, Ambetter / Centene, or Home State Health, offers a negotiated rate that exceeds the cash price, as paying the full cash rate might reduce overall costs.