CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Pennsylvania Hospital
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $205
- Cash Discount Price: $299
- vs. Medicare Baseline: 1.51x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Pennsylvania Hospital is $205. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $299. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.51x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$299
Average discount available for prompt cash payment at this facility.
Insurance Median
$205
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: $299 (221%)
Insurance Median: $205 (151%)
Cash: $299 (221% of Medicare)
Ins. Median: $205 (151% 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 |
|---|---|---|
| Ibc | $35 - $46 | 26% |
| Horizon Nj Health | $44 - $60 | 32% |
| Medicaid / KanCare | $46 - $341 | 34% |
| UnitedHealthcare | $53 - $341 | 39% |
| Health Partners | $57 - $341 | 42% |
| Pgm - Regie De L'Assurance Maladie Quebec | $59 - $79 | 44% |
| Highmark | $64 - $85 | 47% |
| Upmc | $64 - $341 | 47% |
| Preferred Health Care Eliance | $67 - $89 | 49% |
| Blue Cross Blue Shield | $70 - $341 | 52% |
| Keystone Mercy Health Plan | $70 | 52% |
| Aetna | $72 - $341 | 53% |
| Cigna | $87 - $131 | 64% |
| Claims Watcher | $90 - $341 | 66% |
| Pgm - Kuwait Defense | $90 - $154 | 66% |
| Us Family Health Plan | $90 - $119 | 66% |
| Devon | $98 - $154 | 72% |
| Qualcare | $98 - $130 | 72% |
| Coventry | $103 - $174 | 76% |
| Pgm - Chop | $103 - $137 | 76% |
| Wissahickon Hospice | $103 - $137 | 76% |
| Healthamerica/Coventry | $116 - $167 | 86% |
| Olympus | $125 - $166 | 92% |
| First Health Global | $129 - $171 | 95% |
| Penn Global Medicine | $129 - $171 | 95% |
| Urn-Cancer Resource Services | $129 - $171 | 95% |
| Health Net | $155 - $205 | 114% |
| Pgm - Royal Embassy Of Saudi Arabia | $155 - $205 | 114% |
| Pgm - Embassy Of Qatar | $167 - $222 | 123% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $167 - $222 | 123% |
| Pgm - Embassy Of The United Emirates/Ipc | $180 - $239 | 133% |
| Devon Health Services Inc | $206 - $273 | 152% |
| Health America/Ccn | $206 - $273 | 152% |
| Humana | $206 - $341 | 152% |
| Intergroup | $206 - $273 | 152% |
| Pgm - Kuwait Health Division | $206 - $273 | 152% |
| Pgm - Kuwait Oil | $206 - $273 | 152% |
| Preferred Care | $206 - $273 | 152% |
| Centivo | $258 - $341 | 190% |
| Clover Health Plan | $258 - $341 | 190% |
| Commercial Other | $258 - $341 | 190% |
| Community Behavioral Health | $258 - $341 | 190% |
| Elap | $258 - $341 | 190% |
| Elap Services | $258 - $341 | 190% |
| Gateway Health Plan | $258 - $341 | 190% |
| Geisinger Health Plan | $258 - $341 | 190% |
| International Pfs | $258 - $341 | 190% |
| Keystone First | $258 - $341 | 190% |
| Medicare (plans) | $258 - $341 | 190% |
| Oscar Health Plan | $258 - $341 | 190% |
| Pa Health And Wellness | $258 - $341 | 190% |
| Quest Behavioral Health | $258 - $341 | 190% |
| Tricare | $258 - $341 | 190% |
| United Behavioral Health | $258 - $341 | 190% |
| Workers Compensation | $258 - $341 | 190% |