CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Allegheny General Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $100
  • Cash Discount Price: $600
  • vs. Medicare Baseline: 0.74x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Allegheny General Hospital is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $600. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.74x the Medicare baseline. Located in 320 East North Avenue, Pittsburgh, PA.
Cash / Self-Pay
$600

Average discount available for prompt cash payment at this facility.

Insurance Median
$100

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: $600 (442%)
Insurance Median: $100 (74%)
Cash: $600 (442% of Medicare)
Ins. Median: $100 (74% 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
UnitedHealthcare $21 - $150 15%
Amerihealth $57 - $90 42%
Carelon $57 - $154 42%
Aetna $65 48%
Pennsylvania Health And Wellness $72 - $82 53%
Highmark Wholecare $75 55%
Geisinger $79 - $87 58%
Univera $82 - $109 60%
Highmark $84 - $103 62%
Life Pittsburgh $91 67%
Community Care Behavorial Health Healthchoices $92 - $262 68%
Community Care Behavorial Health University Of Pittsburgh Medical Center $92 - $262 68%
Medicare (plans) $96 71%
American Health Plans $100 74%
Cigna $155 114%
Martin'S Point $272 201%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 320 East North Avenue, Pittsburgh, PA 15212
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals