CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Virginia Gay Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $158
Cash Discount Price: $270
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Virginia Gay Hospital is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $270. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.34x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$270

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $270 (230%)

Insurance Median: $158 (134%)

Cash: $270 (230% of Medicare)

Ins. Median: $158 (134% 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
UnitedHealthcare	$35 - $168	30%
Va Ccn-All Plans	$38 - $131	32%
Health Alliance Mcr Adv	$40 - $174	34%
Medicaid / KanCare	$44 - $355	37%
Wellmark Hmo	$55 - $188	47%
Wellmark Ppo-All Other Plans	$55 - $188	47%
Humana	$70 - $283	60%
Medical Associates-All Plans	$77 - $266	65%
Cedar Valley Community Healthcare-All Plans	$81 - $279	69%
Health Partners-All Plans	$87 - $301	74%
Healthsmart-All Plans	$87 - $301	74%
Midlands Choice-All Plans	$115	98%
Health Alliance-All Other Plans	$118 - $336	100%
Corvel-All Plans	$121 - $329	103%
Aetna	$126 - $343	107%

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 $270.
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 Virginia Gay 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.