CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Franciscan Health Munster

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $264
Cash Discount Price: $90
vs. Medicare Baseline: 1.95x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Franciscan Health Munster is $264. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.95x the Medicare baseline. Located in 701 Superior Ave, Munster, IN.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$264

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: $90 (66%)

Insurance Median: $264 (195%)

Cash: $90 (66% of Medicare)

Ins. Median: $264 (195% 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
Medicare (plans)	$141	104%
Cigna	$164 - $311	121%
Commercial [2001]	$186 - $311	137%
Managed Care [2000]	$186 - $342	137%
United Medical Resources [1158]	$186 - $342	137%
United Medical Resources [1301]	$186 - $342	137%
UnitedHealthcare	$186 - $342	137%
Blue Cross Blue Shield	$194 - $342	143%
Aetna	$252 - $296	186%
Great West Insurance [1055]	$264 - $311	195%
Workers Comp [1172]	$282	208%

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 $90.
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 Franciscan Health Munster 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.