Office visit, established patient (20-29 min)
Facility: UPMC Children's Hospital of Pittsburgh
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $167
- Cash Discount Price: $213
- vs. Medicare Baseline: 1.75x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $63 - $195 | 66% |
| Cigna | $64 - $195 | 67% |
| Upmc Health Plan | $81 - $156 | 85% |
| Ccbhn | $114 | 120% |
| Amerihealth Caritas | $131 | 138% |
| Health Partners Plans (Jefferson Health Plan) | $135 | 142% |
| UnitedHealthcare | $139 - $167 | 146% |
| Highmark Wholecare (Prev Gateway) | $141 | 148% |
| Pa Health & Wellness | $142 | 149% |
| Geisinger | $144 - $160 | 151% |
| Blue Cross Blue Shield | $153 - $231 | 161% |
| Health Plan Of Upper Ohio Valley | $231 | 243% |
| Intergroup | $231 - $302 | 243% |
| Coventry/First Health | $284 | 298% |
| Saudi Armed Forces | $284 | 298% |
| Health Payors Organization | $302 | 317% |
| Multiplan | $302 | 317% |
| National Provider Network | $320 | 336% |
| Private Health Care Systems | $320 | 336% |