CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 99213 (CPT)

The BaseRate · fair price medium confidence
A fair price for this
$78
about 0.8× the $95 Medicare rate · typically $48–$168
modeled estimate · not a bill or quote
What this hospital charges insurers
$141
Well above the fair price
about $63 over the fair price · 1.5× Medicare
Medicare pays $95 Fair price $78 This hospital $141 Cash price $213 Hospital's list price $355

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Highest price of the 9 PA hospitals we have prices for — worth calling around.

Cheapest $25 Priciest $141

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $78 (about 0.8× the $95 Medicare rate). UPMC Children's Hospital of Pittsburgh charges insurers about $141, or about $213 in cash — well above the fair price. Located in Pittsburgh, PA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $78. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $139 - $167 146%
Blue Cross Blue Shieldmajor $141 - $231 148%
Aetnamajor $63 - $195 66%
Cignamajor $64 - $195 67%
AmeriHealth $131 138%
Geisinger $144 - $160 151%
HealthPartners $135 142%
UPMC Health Plan $81 - $156 85%
+ 7 smaller / regional plans $142 - $320
Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

Enter your details and press estimate to compare.

Facility Profile & Credentials

  • Address: One Children's Hospital Drive, Pittsburgh, PA 15224
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Childrens