CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Marion Communtiy Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $305
Cash Discount Price: $1,643
vs. Medicare Baseline: 2.59x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Marion Communtiy Hospital is $305. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,643. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 2.59x the Medicare baseline. Located in 1431 Sw 1St Ave, Ocala, FL.

Cash / Self-Pay

$1,643

Average discount available for prompt cash payment at this facility.

Insurance Median

$305

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: $1,643 (1397%)

Insurance Median: $305 (259%)

Cash: $1,643 (1397% of Medicare)

Ins. Median: $305 (259% 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 259% of the Medicare baseline (a markup of 159%). 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
Corvel Corporation	$82 - $241	70%
Prime Health	$83 - $246	71%
Careworks (Rockport Community)	$86 - $254	73%
Marion County Schools	$86 - $254	73%
Aetna	$93 - $512	79%
Blue Cross Blue Shield	$100 - $430	85%
Simply	$243 - $263	207%
Cigna	$275 - $710	234%
United	$275 - $768	234%
Molina Healthcare	$300 - $546	255%
Humana	$316 - $341	269%
Sunshine State Health Plan	$403 - $435	343%
Plotkin Health	$790 - $853	672%
Prime Health Sheriff	$790 - $853	672%
Wellpath	$948 - $1,024	806%
Multiplan	$1,232 - $1,331	1048%
Ppo Next	$1,343 - $1,450	1142%
Novanet	$1,422 - $1,536	1209%
American Health Plan	$15,000	12758%

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 $1,643.
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 Marion Communtiy 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.