CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Reading Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $99
  • Cash Discount Price: $170
  • vs. Medicare Baseline: 0.73x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Reading Hospital is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $170. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.73x the Medicare baseline. Located in 420 S 5Th Avenue, West Reading, PA.
Cash / Self-Pay
$170

Average discount available for prompt cash payment at this facility.

Insurance Median
$99

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: $170 (125%)
Insurance Median: $99 (73%)
Cash: $170 (125% of Medicare)
Ins. Median: $99 (73% 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
Geisinger $48 - $156 35%
UnitedHealthcare $58 - $200 43%
Magellan $61 45%
Aetna $70 - $200 52%
Humana $70 - $85 52%
Blue Cross Blue Shield $82 - $159 60%
Highmark $82 - $103 60%
Upmc $82 - $133 60%
Amerihealth Caritas $83 61%
Health America $85 63%
Devoted Health $86 63%
Health Partners $86 - $133 63%
Pa Health & Wellness $86 - $132 63%
Gateway $88 - $133 65%
Pma $99 73%
Quest Behavioral Health $104 77%
Lehigh Valley Health Network $105 - $150 77%
United Behavioral Health $120 88%
Cigna $128 - $183 94%
First Health $140 - $200 103%
Berkshire $185 136%
Blue Ridge $235 173%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 420 S 5Th Avenue, West Reading, PA 19611
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals