CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Veterans Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $132
  • Cash Discount Price: $147
  • vs. Medicare Baseline: 1.12x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Veterans Memorial Hospital is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.12x the Medicare baseline. Located in 40 1St Street Se, Waukon, IA.
Cash / Self-Pay
$147

Average discount available for prompt cash payment at this facility.

Insurance Median
$132

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: $147 (125%)
Insurance Median: $132 (112%)
Cash: $147 (125% of Medicare)
Ins. Median: $132 (112% 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.

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
Quartz Comm - All Other Plans $65 - $231 55%
Amerigroup Mcaid - All Other Plans $67 - $308 57%
Humana $67 - $231 57%
Iowa Total Care Exchange $67 - $132 57%
Amerigroup Mcr Adv $89 - $132 76%
Iowa Total Care Mcr Adv $89 - $132 76%
Medica Mcr Adv $89 - $132 76%
Molina Mcr Adv $89 - $132 76%
Quartz Mcr Adv $89 - $132 76%
UnitedHealthcare $89 - $262 76%
Welmark Mcr Adv $89 - $132 76%
Iowa Total Care Mcaid - All Other Plans $106 - $308 90%
Molina Mcaid - All Other Plans $106 - $308 90%
Aetna $139 - $206 118%
Medica Comm - All Other Plans $231 196%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 40 1St Street Se, Waukon, IA 52172
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals