CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: UPMC Kane

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $73
Cash Discount Price: $103
vs. Medicare Baseline: 0.62x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at UPMC Kane is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.62x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $103 (88%)

Insurance Median: $73 (62%)

Cash: $103 (88% of Medicare)

Ins. Median: $73 (62% 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
Blue Cross Blue Shield	$58 - $71	49%
UPMC Health Plan	$60 - $213	51%
Aetna	$60 - $66	51%
UnitedHealthcare	$62 - $70	53%
Cigna	$64 - $3,872	54%
Highmark Wholecare (Prev Gateway)	$65 - $80	55%
Amerihealth Caritas	$69 - $85	59%
Geisinger	$75	64%
PA Health & Wellness	$92	78%
Horizon Health Plan	$120	102%
UPMC Work Partners	$127	108%
Multiplan	$129	110%
Intergroup	$138	117%
Health Coalition Partners	$138	117%
Focus Healthcare	$140 - $163	119%

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 $103.
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 UPMC Kane 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.