CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: UPMC Chautauqua at Wca

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $122
Cash Discount Price: $127
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at UPMC Chautauqua at Wca is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.28x the Medicare baseline. Located in 207 Foote Avenue, Jamestown, NY.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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: $127 (133%)

Insurance Median: $122 (128%)

Cash: $127 (133% of Medicare)

Ins. Median: $122 (128% 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
United Behavioral Health	$32	34%
Upmc Health Plan	$44 - $156	46%
Fidelis	$49	51%
Geisinger	$49	51%
Health Partners Plans (Jefferson Health Plan)	$53	56%
Univera	$58 - $61	61%
Aetna	$59 - $169	62%
Magnacare	$65 - $195	68%
Ccbhn	$82	86%
UnitedHealthcare	$104 - $169	109%
Humana	$122 - $208	128%
Multiplan	$122 - $195	128%
Independent Health	$129 - $151	136%
Ghi/Emblem Health	$130 - $208	137%
Statewide Independent Ppo	$143 - $229	150%
Affordable First Health	$147 - $234	154%

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 $127.
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 Chautauqua at Wca 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.