CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Joseph Health System, LLC

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $97
Cash Discount Price: $61
vs. Medicare Baseline: 0.72x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at St Joseph Health System, LLC is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.72x the Medicare baseline. Located in 702 Van Buren St., Fort Wayne, IN.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $61 (45%)

Insurance Median: $97 (72%)

Cash: $61 (45% of Medicare)

Ins. Median: $97 (72% 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
Amish Aid	$36 - $39	27%
Self Pay	$36 - $89	27%
Php	$38 - $65	28%
Lutheran Preferred	$43 - $97	32%
Php Freedom Network	$48 - $51	35%
Cigna	$49 - $162	36%
Blue Cross Blue Shield	$55 - $59	41%
Lutheran Network	$68 - $89	50%
Three Rivers	$68 - $73	50%
Aetna	$70 - $110	52%
Encore Ppo	$78 - $146	58%
Sagamore	$79 - $88	58%
Bccp In	$104	77%
Multiplan	$105 - $126	77%
First Health	$114 - $122	84%
Prime Health Services	$114 - $122	84%
Veterans Eval Services	$118	87%
Align Network	$122 - $130	90%
Frontpath Health Coalition	$122 - $130	90%
Advantage Health Solutions	$126 - $134	93%
Allied Benefit Systems	$137 - $146	101%
Medical Mutual Of Ohio	$152 - $162	112%
Parkview Healthplan Services	$152 - $162	112%
Value Options	$152 - $162	112%

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 $61.
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 St Joseph Health System, LLC 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.