CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Cambridge Health Alliance
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $175
- Cash Discount Price: $230
- vs. Medicare Baseline: 1.29x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Cambridge Health Alliance is $175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $230. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.29x the Medicare baseline. Located in 1493 Cambridge Street, Cambridge, MA.
Cash / Self-Pay
$230
Average discount available for prompt cash payment at this facility.
Insurance Median
$175
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: $230 (170%)
Insurance Median: $175 (129%)
Cash: $230 (170% of Medicare)
Ins. Median: $175 (129% 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.
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 |
|---|---|---|
| Blue Cross Blue Shield | $30 - $285 | 22% |
| Other Tufts Health Public Plan [75002] | $37 | 27% |
| Mass Bh Partnership [70098] | $60 | 44% |
| Aarp [40001] | $66 - $185 | 49% |
| Oxford Health [40004] | $66 - $185 | 49% |
| United Medical Resource [40005] | $66 - $185 | 49% |
| UnitedHealthcare | $66 - $185 | 49% |
| Wc [90001] | $74 | 55% |
| Health Plans Inc [20002] | $96 - $157 | 71% |
| Hphc [20001] | $96 - $157 | 71% |
| Mass General Brigham [50021] | $111 - $181 | 82% |
| Multiplan [50010] | $119 - $194 | 88% |
| Wellpoint [50012] | $120 | 88% |
| Cigna | $141 - $285 | 104% |
| Aetna | $175 - $285 | 129% |
| Altus Dental [99011] | $175 - $285 | 129% |
| Beacon Health Strategies [50002] | $175 - $285 | 129% |
| Cbhc Uninsured Crisis Alt Payer [70097] | $175 - $285 | 129% |
| Cbhc Uninsured Crisis [70096] | $175 - $285 | 129% |
| Celticare [50004] | $175 - $285 | 129% |
| Commonwealth Care Alliance Dental [99004] | $175 - $285 | 129% |
| Coverage Discovery [90004] | $175 - $285 | 129% |
| Delta Dental Of Ma [99007] | $175 - $285 | 129% |
| Dominion National Dental [99012] | $175 - $285 | 129% |
| Dph Tb Payor [85004] | $175 - $285 | 129% |
| Esp Dental [99003] | $175 - $285 | 129% |
| Eyemed Alt Payor [13001] | $175 - $285 | 129% |
| First Health [50007] | $175 - $285 | 129% |
| Global Medical Management [50024] | $175 - $285 | 129% |
| Government Employee Health Association [50023] | $175 - $285 | 129% |
| Guardian Dental [99013] | $175 - $285 | 129% |
| Health Safety Net Dental [99002] | $175 - $285 | 129% |
| Humana | $175 - $285 | 129% |
| Ma Laborers Health And Welfare Fund [50022] | $175 - $285 | 129% |
| Magellan Health Services [65098] | $175 - $285 | 129% |
| Mass Health Dental [99001] | $175 - $285 | 129% |
| Medical Mutual Of Ohio [50019] | $175 - $285 | 129% |
| Medicare (plans) | $175 - $285 | 129% |
| Metlife Dental [99008] | $175 - $285 | 129% |
| Modern Assistance Program [30098] | $175 - $285 | 129% |
| Mva [90002] | $175 - $285 | 129% |
| Neighborhood Health Plan [50011] | $175 - $285 | 129% |
| Other Bh Payor [50014] | $175 - $285 | 129% |
| Other Commercial Payor [50015] | $175 - $285 | 129% |
| Other Dental Payor [99014] | $175 - $285 | 129% |
| Other Dual Eligible Payer [65004] | $175 - $285 | 129% |
| Other Gov'T Alt [85006] | $175 - $285 | 129% |
| Other Vision Payor [50013] | $175 - $285 | 129% |
| Ri Neighborhood Health Plan [50017] | $175 - $285 | 129% |
| Tricare | $175 - $285 | 129% |