CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Punxsutawney Area Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $90
Cash Discount Price: $66
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Punxsutawney Area Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.95x the Medicare baseline. Located in 81 Hillcrest Drive, Punxsutawney, PA.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $66 (69%)

Insurance Median: $90 (95%)

Cash: $66 (69% of Medicare)

Ins. Median: $90 (95% 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	$28 - $137	29%
UnitedHealthcare	$38 - $104	40%
Highmark Wholecare	$44 - $91	46%
Geisinger Health Plan	$53 - $91	56%
Ambetter / Centene	$54 - $96	57%
Highmark	$54 - $90	57%
Amerihealth Caritas	$60 - $90	63%
Tricare	$77 - $260	81%
Aetna	$90	95%
Cigna	$91 - $154	96%
United Mine Workers Of America	$91	96%
Pa Health And Wellness Commercial	$114	120%
Geisinger	$127	133%
Pa Workers Compensation	$154 - $260	162%

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 $66.
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 Punxsutawney Area Hospital 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.