CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Clearwater Valley Hospital & Clinics

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $120
Cash Discount Price: $89
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Clearwater Valley Hospital & Clinics is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.02x the Medicare baseline. Located in 301 Cedar Street, Orofino, ID.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $89 (76%)

Insurance Median: $120 (102%)

Cash: $89 (76% of Medicare)

Ins. Median: $120 (102% 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
Humana	$61 - $215	52%
Aetna	$64 - $206	54%
Blue Cross Blue Shield	$64 - $218	54%
Nimiipuu Mcr Adv-All Plans	$64 - $121	54%
Pacific Source - All Plans	$64 - $155	54%
Regence Blue Shield Mcr	$64 - $120	54%
Veterans Amin-All Plans	$64 - $120	54%
Corizon Correctnal Med-All Plans	$86 - $162	73%
Idaho Phys Network-All Plans	$99 - $211	84%
Multiplan / Phcs-All Plans	$100 - $215	85%
Geha-All Plans	$101 - $218	86%
First Choice-All Plans	$102 - $218	87%
Regence Blue Shield-All Other Plans	$118 - $222	100%
UnitedHealthcare	$128	109%
Cigna	$157	134%

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 $89.
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 Clearwater Valley Hospital & Clinics 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.