CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Lutheran Hospital of Indiana

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $45
Cash Discount Price: $31
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Lutheran Hospital of Indiana is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.47x the Medicare baseline. Located in 7950 W Jefferson Blvd, Fort Wayne, IN.

Cash / Self-Pay

$31

Average discount available for prompt cash payment at this facility.

Insurance Median

$45

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $31 (33%)

Insurance Median: $45 (47%)

Cash: $31 (33% of Medicare)

Ins. Median: $45 (47% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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
Amish Aid	$10 - $42	11%
Lutheran Preferred Network	$10 - $83	11%
Self Pay	$10 - $50	11%
Cigna	$11 - $50	12%
Physicians Health Plan Of Northern Indiana	$11 - $55	12%
Php Freedom Network	$12 - $46	13%
Blue Cross Blue Shield	$13 - $52	14%
Aetna	$14 - $66	15%
Ky Work Comp	$14 - $35	15%
Lutheran Preferred	$14 - $56	15%
Sagamore	$16 - $75	17%
Encore Ppo	$17 - $68	18%
Lutheran Network	$18 - $70	19%
Multiplan	$26 - $115	27%
Prime Health Services	$26 - $104	27%
Advantage Health Solutions	$29 - $115	30%
Encore Health Network	$29 - $125	30%
Allied Benefit Systems	$32 - $125	34%
Evolutions	$32 - $125	34%
Veterans Eval Services	$35 - $84	37%
One Call Care Diagnostics	$55	58%
Bccp In	$71	75%

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 $31.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lutheran Hospital of Indiana is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
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.