CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Lecom Medical Center and Behavioral Health Pav

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $209
  • Cash Discount Price: $209
  • vs. Medicare Baseline: 1.78x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Lecom Medical Center and Behavioral Health Pav is $209. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.78x the Medicare baseline. Located in 5515 Peach Street, Erie, PA.
Cash / Self-Pay
$209

Average discount available for prompt cash payment at this facility.

Insurance Median
$209

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $209 (178%)
Insurance Median: $209 (178%)
Cash: $209 (178% of Medicare)
Ins. Median: $209 (178% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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.

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_Commercial $93 79%
Upmc_For_Life $93 79%
Upmc_For_Life_Hmo_Premier_Rx $93 79%
Upmc_Partner $93 79%
Upmc_Value $93 79%
Upmc_Value_Select $93 79%
UnitedHealthcare $110 94%
Healthchoice_Berks $209 178%
Healthchoice_Blair $209 178%
Healthchoice_Carbon_Monroe_Pike $209 178%
Healthchoice_Chester $209 178%
Healthchoice_Erie $209 178%
Healthchoice_Lycoming_Clinton $209 178%
Healthchoice_Northcentral $209 178%
Healthchoice_Northeast $209 178%
Healthchoice_Somerset_Bedford $209 178%
Healthchoice_York_Adams $209 178%
Medicare (plans) $209 178%
Aetna $230 196%
Cigna $288 245%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5515 Peach Street, Erie, PA 16509
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals