CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: North Central Health Care

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $226
  • Cash Discount Price: $379
  • vs. Medicare Baseline: 1.67x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at North Central Health Care is $226. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $379. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.67x the Medicare baseline. Located in 1150 Lakeview Dr, Wausau, WI.
Cash / Self-Pay
$379

Average discount available for prompt cash payment at this facility.

Insurance Median
$226

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: $379 (279%)
Insurance Median: $226 (167%)
Cash: $379 (279% of Medicare)
Ins. Median: $226 (167% 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.

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
Medicaid / KanCare $145 107%
UnitedHealthcare $222 - $226 164%
Blue Cross Blue Shield $223 - $226 164%
Medicare (plans) $223 164%
90 Degree Benefits $226 167%
Advantage By Managed $226 167%
Aetna $226 167%
Aither Health Plan $226 167%
All Savers $226 167%
Ama Insurance Agency Inc $226 167%
Arise Health Plan $226 167%
Aspirus Health Plan $226 167%
Aspirus Health Plan - First Health Network $226 167%
Chorus Community Health Plan $226 167%
Cigna $226 167%
Dean Care $226 167%
Golden Rule Insurance $226 167%
Health Eos - Multiplan $226 167%
Health Partners $226 167%
Humana $226 167%
I - Care $226 167%
Medica Claims $226 167%
Merchants Benefits Administrat $226 167%
Meritain Health $226 167%
Moda Health $226 167%
Molina $226 167%
Molina Insurance $226 167%
North American Insurance $226 167%
Physicians Mutual Insurance $226 167%
Premier Access Inc $226 167%
Redirect Administrators $226 167%
Security Administrative Services $226 167%
Surest $226 167%
The Alliance $226 167%
United Behavioral Health $226 167%
Wisconsin Physicians Service $226 167%
Group Health Cooperative $237 175%
Cenpatico $242 178%
Security Health Plan $247 182%
Security Health Plan - HMO $247 182%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1150 Lakeview Dr, Wausau, WI 54403
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Psychiatric