CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Froedtert Memorial Lutheran Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $190
Cash Discount Price: $185
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Froedtert Memorial Lutheran Hospital is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.40x the Medicare baseline. Located in 9200 W Wisconsin Ave, Milwaukee, WI.

Cash / Self-Pay

$185

Average discount available for prompt cash payment at this facility.

Insurance Median

$190

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: $185 (136%)

Insurance Median: $190 (140%)

Cash: $185 (136% of Medicare)

Ins. Median: $190 (140% 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
Sheboygan Employers Health Network	$46	34%
Blue Cross Blue Shield	$119	88%
Community Care	$119	88%
Health Partners	$119 - $269	88%
Humana	$119	88%
Icare	$119	88%
Molina	$119	88%
Network Health Plan	$119	88%
Priority Health	$119	88%
Quartz	$119	88%
Security Health Plan	$119 - $341	88%
UnitedHealthcare	$119	88%
Upper Peninsula Health Plan	$119	88%
Aetna	$122 - $282	90%
Wellcare	$122	90%
Care Wisconsin/Mychoice	$123	91%
Wisconsin Physician Services Statewide Alliance	$149 - $273	110%
Trilogy	$154 - $282	114%
Health Payment Systems	$156 - $286	115%
Dean Health Plan	$190 - $347	140%
Group Health Cooperative	$190 - $347	140%
Healtheos	$190 - $347	140%
Multiplan/Private Healthcare Systems	$190 - $347	140%
Healthsmart	$197 - $360	145%
Wisconsin Physician Services	$201 - $369	148%
First Health Network	$205 - $375	151%

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 $185.
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 Froedtert Memorial 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.