CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: UPMC Hamot

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $104
Cash Discount Price: $157
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at UPMC Hamot is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.09x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$157

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $157 (165%)

Insurance Median: $104 (109%)

Cash: $157 (165% of Medicare)

Ins. Median: $104 (109% 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
Upmc Health Plan	$38	40%
Univera	$39 - $115	41%
UnitedHealthcare	$40	42%
Aetna	$42 - $183	44%
Geisinger	$49	51%
Highmark Wholecare (Prev Gateway)	$52 - $130	55%
Health Partners Plans (Jefferson Health Plan)	$53	56%
Blue Cross Blue Shield	$54 - $198	57%
Amerihealth Caritas	$55	58%
Pa Health & Wellness	$60	63%
Cigna	$64 - $104	67%
Upmc Work Partners	$88	92%
Independent Health	$151 - $161	159%
Intergroup	$170 - $209	179%
Multiplan	$183 - $209	192%

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 $157.
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 Hamot 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.