CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Lutheran Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $240
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.77x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Lutheran Medical Center is $240. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.77x the Medicare baseline. Located in 8300 W 38Th Ave, Wheat Ridge, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$240

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%)

Insurance Median: $240 (177%)

Ins. Median: $240 (177% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Kaiser Perm Hmo	$78 - $177	58%
Kaiser Self Funded	$96 - $177	71%
Kaiser Perm Ppo/Pos	$98 - $182	72%
Allegiance	$105	77%
Cigna	$105 - $419	77%
Aetna	$156 - $376	115%
Blue Cross Blue Shield	$167 - $352	123%
Geha	$167 - $243	123%
Preferred One	$167	123%
Humana	$176	130%
UnitedHealthcare	$182 - $243	134%
Cofinity	$302	223%
First Health Network	$302	223%
Private Hlthcare Sys	$314	232%
Multiplan Inc	$352	260%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lutheran Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.