CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: St Mary's Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $117
Cash Discount Price: $89
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at St Mary's Hospital is $117. 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 1.00x the Medicare baseline. Located in 701 Lewiston St, Cottonwood, ID.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $117 (100%)

Cash: $89 (76% of Medicare)

Ins. Median: $117 (100% 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
Tricare	$68 - $182	58%
Veterans Admin - All Plans	$68 - $182	58%
Blue Cross Blue Shield	$85 - $218	72%
Aetna	$97 - $206	83%
Medicare (plans)	$97 - $182	83%
Regence Blue Shield Mcr	$97 - $182	83%
UnitedHealthcare	$97 - $182	83%
Nimiipuu Mcr Adv - Allplans	$98 - $184	83%
Idaho Phys Network - All Plans	$99 - $211	84%
Multiplan - All Plans	$100 - $215	85%
Geha - All Plans	$101 - $215	86%
First Choice- All Plans	$102 - $218	87%
Corizon Correctional - All Plans	$114 - $213	97%
Regence Blue Shield - All Other Plans	$118 - $222	100%

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 St Mary's 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.