CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Geisinger Jersey Shore Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $154
Cash Discount Price: $179
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Geisinger Jersey Shore Hospital is $154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $179. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.62x the Medicare baseline. Located in 1020 Thompson Street, Jersey Shore, PA.

Cash / Self-Pay

$179

Average discount available for prompt cash payment at this facility.

Insurance Median

$154

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: $179 (188%)

Insurance Median: $154 (162%)

Cash: $179 (188% of Medicare)

Ins. Median: $154 (162% 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
Blue Cross Blue Shield	$35 - $212	37%
Medicaid / KanCare	$35	37%
Amerihealth	$38	40%
Geisinger Family Plan	$38	40%
Upmc For You	$41	43%
Health Partners	$42	44%
Geisinger Health Plan	$44 - $175	46%
Upmc Chip	$44	46%
UnitedHealthcare	$98	103%
Cigna	$106	111%
Christian Healthcare Ministries	$110 - $178	116%
Aetna	$153 - $273	161%
Medical Development International	$154 - $250	162%
Integrated Health Plan	$165 - $268	173%
Prime Health Services	$165 - $268	173%
Multiplan	$176 - $286	185%

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 $179.
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 Geisinger Jersey Shore 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.