CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: McLaren Lapeer Region

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $84
Cash Discount Price: $72
vs. Medicare Baseline: 0.62x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at McLaren Lapeer Region is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.62x the Medicare baseline. Located in 1375 N Main St, Lapeer, MI.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $72 (53%)

Insurance Median: $84 (62%)

Cash: $72 (53% of Medicare)

Ins. Median: $84 (62% 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
Mclaren Commercial Ins	$35 - $72	26%
Workers Compensation	$53	39%
Medicaid / KanCare	$62 - $64	46%
Priority Health	$64 - $107	47%
Aetna	$79 - $101	58%
Cofinity Group 15892 & 15893	$79	58%
Humana	$84	62%
Medicare (plans)	$84 - $86	62%
UnitedHealthcare	$87 - $135	64%
Hap - Hmo	$95	70%
U Of M Health Plan	$96	71%
Blue Cross Blue Shield	$124	91%

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 $72.
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 McLaren Lapeer Region 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.