CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $116
Cash Discount Price: $176
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at St Anthony Regional Hospital & Nursing Home is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $176. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.99x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.

Cash / Self-Pay

$176

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $176 (150%)

Insurance Median: $116 (99%)

Cash: $176 (150% of Medicare)

Ins. Median: $116 (99% 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	$29 - $89	25%
Va Ccn - All Plans	$67	57%
Humana	$70 - $216	60%
Ia Total Care Mcaid	$82 - $254	70%
Wellpoint Mcaid - All Other Plans	$82 - $254	70%
Molina Mcaid - All Plans	$84 - $259	71%
Ia Total Care Comm - All Other Plans	$87	74%
Aetna	$115 - $137	98%
Wellmark Hmo	$116	99%
Wellmark Ppo-All Other Plans	$116	99%
Midlands Choice - All Plans	$120	102%

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 $176.
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 St Anthony Regional Hospital & Nursing Home 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.