Office visit, established patient (30-39 min)
Facility: Sky Lakes Medical Center
Billing Code: 99214 (CPT)
This hospital's typical commercial price is $143 compared to the $126 fair price benchmark.
2-Star CMS clinical quality rating paired with 1.13× fair market pricing.
On the higher side — 7 of 8 other OR hospitals charge less.
Black dot = this hospital, among the 9 OR hospitals with a price for this procedure. Full list below.
A fair price for a Office visit, established patient (30-39 min) is about $126 (about 0.9× the $136 Medicare rate). Sky Lakes Medical Center charges insurers about $143, or about $153 in cash — about the fair price. Located in Klamath Falls, OR.
What each insurance company pays
Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.
6 of 6 major insurers have a published price at this hospital
Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.
| Insurance company | Price range | vs. Medicare |
|---|---|---|
| UnitedHealthcaremajor | $143 - $431 | 105% |
| Blue Cross Blue Shieldmajor | $143 - $431 | 105% |
| Aetnamajor | $143 - $431 | 105% |
| Cignamajor | $143 - $431 | 105% |
| Humanamajor | $143 - $431 | 105% |
| Kaiser Permanentemajor | $143 - $431 | 105% |
| GEHA | $150 - $431 | 111% |
| Health Net | $150 - $431 | 111% |
| HealthPartners | $150 - $431 | 111% |
| Moda Health | $124 - $431 | 91% |
| MVP Health Care | $150 - $431 | 111% |
| PacificSource | $135 - $387 | 100% |
| Providence Health Plan | $150 - $431 | 111% |
| Sanford Health Plan | $150 - $431 | 111% |
| UPMC Health Plan | $150 - $431 | 111% |
| WellCare | $143 | 105% |
| + 200 smaller / regional plans | $143 - $431 |
Self-Pay How to get the cash price
Insurance Before you use insurance
Estimate your out-of-pocket cost
A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.
Other Procedures at Sky Lakes Medical Center
Compare: Office visit, established patient (30-39 min) at other OR hospitals
- Santiam Hospital & Clinics · Stayton $83
- Wallowa Memorial Hospital · Enterprise $96
- Shriners Hospital for Children - Portland · Portland $109
- St Charles Medical Center - Bend · Bend $124
- Adventist Health Portland · Portland $127
- Lower Umpqua Hospital District · Reedsport $140
- Mid-Columbia Medical Center · The Dalles $141
- St Charles Medical Center Prineville · Prineville $150
Insurance negotiated median for the same procedure, sorted lowest first.
Audit a Bill or Quote at Sky Lakes Medical Center (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $74
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $74).
Self-Pay Cash Rate ($153) Beats Your Bill
Sky Lakes Medical Center's published 45 CFR § 180 self-pay cash rate is $153 (vs. $143 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $126 Fair BaseRate ($136 Medicare)
Your bill ($204) is $78 above the denoised Fair BaseRate ($126) and 1.5× the $136 Medicare rate.
Clinical Quality, Patient Experience & Infection Benchmarks
Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.