CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: UPMC Altoona

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $54
Cash Discount Price: $230
vs. Medicare Baseline: 0.57x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at UPMC Altoona is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $230. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.57x the Medicare baseline. Located in 620 Howard Avenue, Altoona, PA.

Cash / Self-Pay

$230

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $230 (242%)

Insurance Median: $54 (57%)

Cash: $230 (242% of Medicare)

Ins. Median: $54 (57% 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
Aetna	$20 - $204	21%
UnitedHealthcare	$21 - $42	22%
Upmc Health Plan	$22 - $156	23%
Geisinger	$28 - $211	29%
Health Partners Plans (Jefferson Health Plan)	$30 - $60	32%
Highmark Wholecare (Prev Gateway)	$30 - $192	32%
Amerihealth Caritas	$31 - $62	33%
Pa Health & Wellness	$34 - $68	36%
Blue Cross Blue Shield	$54	57%
Upmc Work Partners	$82	86%
Cigna	$192	202%
Preferred Healthcare System	$192	202%
Private Health Care Systems	$307	323%

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 $230.
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 Altoona 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.