CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Lutheran Hospital of Indiana

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $78
Cash Discount Price: $52
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Lutheran Hospital of Indiana is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.58x the Medicare baseline. Located in 7950 W Jefferson Blvd, Fort Wayne, IN.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $52 (38%)

Insurance Median: $78 (58%)

Cash: $52 (38% of Medicare)

Ins. Median: $78 (58% 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
Physicians Health Plan Of Northern Indiana	$32 - $81	24%
Ky Work Comp	$33 - $52	24%
Amish Aid	$39 - $62	29%
Lutheran Preferred Network	$39 - $124	29%
Self Pay	$39 - $74	29%
Cigna	$42 - $75	31%
Php Freedom Network	$43 - $68	32%
Blue Cross Blue Shield	$48 - $76	35%
Aetna	$52 - $98	38%
Lutheran Preferred	$52 - $82	38%
Sagamore	$59 - $111	44%
Encore Ppo	$64 - $101	47%
Lutheran Network	$65 - $103	48%
One Call Care Diagnostics	$81	60%
Multiplan	$95 - $171	70%
Prime Health Services	$98 - $154	72%
Bccp In	$104	77%
Encore Health Network	$107 - $185	79%
Advantage Health Solutions	$108 - $171	80%
Allied Benefit Systems	$117 - $185	86%
Evolutions	$117 - $185	86%
Veterans Eval Services	$118	87%

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 $52.
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 Hospital of Indiana 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.