CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: The Orthopaedic Hospital of Lutheran Health Networ

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $78
Cash Discount Price: $42
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at The Orthopaedic Hospital of Lutheran Health Networ is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.58x the Medicare baseline. Located in 7952 W Jefferson Blvd, Ft Wayne, IN.

Cash / Self-Pay

$42

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: $42 (31%)

Insurance Median: $78 (58%)

Cash: $42 (31% 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	$36 - $63	27%
Amish Aid	$41 - $44	30%
Self Pay	$41 - $44	30%
Lutheran Preferred	$44 - $97	32%
Php Freedom Network	$48 - $51	35%
Cigna	$53 - $162	39%
Aetna	$59 - $79	44%
Three Rivers Preferred	$61 - $73	45%
Sagamore	$73 - $88	54%
Encore Ppo	$76 - $81	56%
Bccp	$104	77%
Multiplan	$105 - $126	77%
Prime Health Services	$114 - $122	84%
First Health	$117 - $125	86%
Encore	$122 - $130	90%
One Call Work Comp	$122	90%

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 $42.
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 The Orthopaedic Hospital of Lutheran Health Networ 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.