CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: UPMC St Margaret

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $126
Cash Discount Price: $229
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at UPMC St Margaret is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.93x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $229 (169%)

Insurance Median: $126 (93%)

Cash: $229 (169% of Medicare)

Ins. Median: $126 (93% 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
Aetna	$36 - $152	27%
UnitedHealthcare	$60	44%
Upmc Health Plan	$60	44%
Blue Cross Blue Shield	$64 - $335	47%
Cigna	$64 - $152	47%
Highmark Wholecare (Prev Gateway)	$81 - $190	60%
Amerihealth Caritas	$85	63%
Pa Health & Wellness	$93	69%
Upmc Work Partners	$136	100%
Coventry/First Health	$267	197%
Private Health Care Systems	$305	225%
Selectcare	$305	225%
Humana	$324	239%

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 $229.
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 St Margaret 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.