CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: HCA Healthone Presbyterian St Luke's

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $422
Cash Discount Price: $700
vs. Medicare Baseline: 3.11x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at HCA Healthone Presbyterian St Luke's is $422. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $700. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.11x the Medicare baseline. Located in 1719 E 19Th Ave, Denver, CO.

Cash / Self-Pay

$700

Average discount available for prompt cash payment at this facility.

Insurance Median

$422

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: $700 (516%)

Insurance Median: $422 (311%)

Cash: $700 (516% of Medicare)

Ins. Median: $422 (311% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 311% of the Medicare baseline (a markup of 211%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Vail Health	$90 - $233	66%
Kaiser	$118 - $398	87%
United	$123 - $688	91%
Cigna	$172 - $979	127%
Aetna	$178 - $808	131%
Bright Health	$178 - $459	131%
Emerging Therapy Solutions	$284 - $979	209%
Kaiser National Transplant	$284 - $734	209%
Colorado Program For Children With Special Needs	$302 - $780	223%
Western Plains Community Health	$385 - $994	284%
Multiplan	$415 - $1,377	306%
Northcare	$415 - $1,071	306%
Physician Health Partners	$415 - $1,071	306%
Blue Cross Blue Shield	$438 - $1,132	323%
Pinnacol Workers Comp	$444 - $1,147	327%
Medical Development International	$474 - $1,224	350%
Triwest Health Alliance	$474 - $1,224	350%
Prime Health	$533 - $1,377	393%

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 $700.
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 HCA Healthone Presbyterian St Luke's 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.