CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Punxsutawney Area Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $111
Cash Discount Price: $162
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Punxsutawney Area Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.94x the Medicare baseline. Located in 81 Hillcrest Drive, Punxsutawney, PA.

Cash / Self-Pay

$162

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $162 (138%)

Insurance Median: $111 (94%)

Cash: $162 (138% of Medicare)

Ins. Median: $111 (94% 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.

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	$52 - $255	44%
Amerihealth Caritas	$60 - $111	51%
UnitedHealthcare	$60 - $168	51%
Highmark	$67 - $111	57%
Highmark Wholecare	$67 - $112	57%
Tricare	$94 - $421	80%
Aetna	$111	94%
United Mine Workers Of America	$112	95%
Geisinger Health Plan	$113	96%
Ambetter / Centene	$118 - $168	100%
Pa Health And Wellness Commercial	$141	120%
Geisinger	$157	134%
Cigna	$250	213%
Pa Workers Compensation	$421	358%

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 $162.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Punxsutawney Area Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.