CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: UPMC Presbyterian Shadyside

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $172
Cash Discount Price: $148
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at UPMC Presbyterian Shadyside is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $148. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.81x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$148

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $148 (155%)

Insurance Median: $172 (181%)

Cash: $148 (155% of Medicare)

Ins. Median: $172 (181% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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 - $62	38%
Upmc Health Plan	$38	40%
UnitedHealthcare	$42	44%
Highmark Wholecare (Prev Gateway)	$52 - $123	55%
Health Partners Plans (Jefferson Health Plan)	$53	56%
Blue Cross Blue Shield	$54 - $302	57%
Geisinger	$54	57%
Amerihealth Caritas	$55	58%
Pa Health & Wellness	$60	63%
Upmc Work Partners	$89	93%
Multiplan	$104 - $197	109%
Preferred Healthcare System	$160	168%
Coventry/First Health	$172	181%
Fidelis	$184	193%
Intergroup	$184 - $209	193%
Health Coalition Partners	$197	207%
Private Health Care Systems	$197	207%
Selectcare	$197	207%
Health Payors Organization	$209	220%
Humana	$209	220%

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 $148.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Presbyterian Shadyside is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
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.