CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: UPMC Hamot

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $119
Cash Discount Price: $178
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at UPMC Hamot is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $178. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.88x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$178

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $178 (131%)

Insurance Median: $119 (88%)

Cash: $178 (131% of Medicare)

Ins. Median: $119 (88% 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
Univera	$45 - $131	33%
Upmc Health Plan	$60	44%
Blue Cross Blue Shield	$63 - $248	46%
UnitedHealthcare	$63	46%
Cigna	$64 - $119	47%
Aetna	$65 - $208	48%
Geisinger	$76	56%
Highmark Wholecare (Prev Gateway)	$81 - $148	60%
Health Partners Plans (Jefferson Health Plan)	$82	60%
Amerihealth Caritas	$85	63%
Pa Health & Wellness	$93	69%
Upmc Work Partners	$136	100%
Independent Health	$151 - $161	111%
Intergroup	$193 - $238	142%
Multiplan	$208 - $238	153%

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 $178.
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 Hamot 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.