CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Sterling Regional Medcenter

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $314
Cash Discount Price: $439
vs. Medicare Baseline: 2.67x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Sterling Regional Medcenter is $314. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $439. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 2.67x the Medicare baseline. Located in 615 Fairhurst St, Sterling, CO.

Cash / Self-Pay

$439

Average discount available for prompt cash payment at this facility.

Insurance Median

$314

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: $439 (373%)

Insurance Median: $314 (267%)

Cash: $439 (373% of Medicare)

Ins. Median: $314 (267% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 267% of the Medicare baseline (a markup of 167%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$92 - $777	78%
Banner Health	$102 - $259	87%
Blue Cross Blue Shield	$102 - $678	87%
Healthspring Life & Health Insurance Company, Inc.	$102 - $259	87%
Medica	$102 - $696	87%
Medicare (plans)	$102 - $259	87%
Assist Health Group	$123 - $311	105%
Pinnacol Assurance Workers Comp	$160 - $406	136%
UnitedHealthcare	$191 - $792	162%
Denver Health Medical Plan	$200 - $506	170%
Apostrophe, Inc.	$297 - $752	253%
First Choice Health Network	$297 - $752	253%
First Choice Of The Midwest	$314 - $793	267%
Hue Health, Inc	$314 - $793	267%
Rocky Mountain Health Plans	$314 - $793	267%
Multiplan	$320 - $810	272%

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 $439.
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 Sterling Regional Medcenter 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.