CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Lutheran Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $90
Cash Discount Price: $112
vs. Medicare Baseline: 0.66x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Lutheran Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.66x the Medicare baseline. Located in 1730 West 25Th Street, Cleveland, OH.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $112 (83%)

Insurance Median: $90 (66%)

Cash: $112 (83% of Medicare)

Ins. Median: $90 (66% 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
Aetna	$38 - $173	28%
Oscar	$52 - $67	38%
Zing Health	$52	38%
UnitedHealthcare	$53 - $107	39%
Paramount	$58	43%
Blue Cross Blue Shield	$59 - $138	44%
Buckeye	$59	44%
Molina	$59	44%
United Bh	$59	44%
Caresource	$60	44%
United	$60	44%
Amerihealth	$62	46%
Summacare	$64 - $70	47%
Cc Ehp	$67 - $69	49%
Aultcare	$74	55%
Amish Community Aid Plan	$78 - $86	58%
Ohcp	$84	62%
Omas	$86	63%
Mmo	$93 - $104	69%
Ohio Healthy	$93	69%
Healthsmart	$95	70%
Php	$104	77%
Phphi	$104	77%
The Health Plan	$104	77%
Upmc	$104	77%
Gms	$121	89%
Medical Benefit Corp	$121	89%
Quality Care Partners	$121	89%
Consociate Health	$130	96%
Managed Care Services	$130	96%
Humana	$147	108%
Frontpath	$156	115%
Multiplan	$156	115%
Tertiary Care Network	$156	115%
Three Rivers	$156	115%
Cigna	$161	119%

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 $112.
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 Lutheran Hospital 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.