CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: UPMC Jameson

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $122
Cash Discount Price: $251
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at UPMC Jameson is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $251. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.90x the Medicare baseline. Located in 1211 Wilmington Avenue, New Castle, PA.

Cash / Self-Pay

$251

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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: $251 (185%)

Insurance Median: $122 (90%)

Cash: $251 (185% of Medicare)

Ins. Median: $122 (90% 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
Blue Cross Blue Shield	$23	17%
Upmc Health Plan	$60 - $185	44%
Aetna	$61 - $110	45%
UnitedHealthcare	$63 - $154	46%
Amerihealth Caritas	$71	52%
Geisinger	$76	56%
Cigna	$86 - $129	63%
Pa Health & Wellness	$93	69%
Upmc Work Partners	$122	90%
Highmark Wholecare (Prev Gateway)	$209	154%
Multiplan	$314 - $334	232%
Humana	$334	246%
National Provider Network	$368	271%

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 $251.
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 UPMC Jameson 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.