CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Dupont Hospital LLC

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $83
Cash Discount Price: $56
vs. Medicare Baseline: 0.61x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Dupont Hospital LLC is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.61x the Medicare baseline. Located in 2520 E Dupont Rd, Fort Wayne, IN.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $56 (41%)

Insurance Median: $83 (61%)

Cash: $56 (41% of Medicare)

Ins. Median: $83 (61% 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	$37 - $63	27%
Amish Aid	$41 - $44	30%
Self Pay	$41 - $73	30%
Lutheran Preferred	$45 - $97	33%
Cigna	$49 - $59	36%
Php Freedom Network	$50 - $54	37%
Aetna	$56 - $72	41%
Encore Ppo	$76 - $81	56%
Lutheran Network	$76 - $81	56%
Medical Mutual Of Oh	$81 - $86	60%
Sagamore	$82 - $90	60%
Bccp	$104	77%
Prime Health Services	$114 - $122	84%
Veterans Eval Services	$118	87%
Frontpath	$122 - $130	90%
Encore Health Network	$125 - $146	92%
Advantage Health Solutions	$126 - $134	93%
Multiplan	$131 - $146	97%
Allied Benefit Systems	$137 - $146	101%

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 $56.
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 Dupont Hospital 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.