CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Mt Sinai Hospital Medical Center

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $155
  • Cash Discount Price: $227
  • vs. Medicare Baseline: 1.32x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Mt Sinai Hospital Medical Center is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $227. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.32x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.
Cash / Self-Pay
$227

Average discount available for prompt cash payment at this facility.

Insurance Median
$155

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: $227 (193%)
Insurance Median: $155 (132%)
Cash: $227 (193% of Medicare)
Ins. Median: $155 (132% 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
Blue Cross Blue Shield $74 - $271 63%
Cigna $74 - $526 63%
Tricare $76 65%
Va Healthnet - All Plans $76 65%
Advocate Physician Prtnrs Mcr $79 67%
Cenpatico Illinicare Dual $79 67%
Cenpatico Illinicare Mcr - All Other Plans $79 67%
Humana $79 - $1,336 67%
Lawndale Christian - All Plans $79 67%
Meridian/Harmony D-Snp - All Plans $79 67%
Nextlevel Hlth Icp Fhp Aca - All Plans $79 67%
UnitedHealthcare $79 - $154 67%
Harmony Behavioral Htlh - All Plans $81 69%
Zing Mcr Adv - All Plans $82 70%
Molina Mcr - All Other Plans $83 71%
Advocate Physician Prtnrs - All Other Plans $87 74%
Ambetter / Centene $87 - $447 74%
Partners In Hlth - All Plans $90 - $170 77%
Compsych Ip/Op Only - All Plans $134 - $255 114%
Healthlink Hmo $145 - $277 123%
Hfn Platinum $145 - $277 123%
Healthlink Ppo - All Other Plans $157 - $298 134%
Multiplan Primary Ntwrk/Phcs - All Other Plans $157 - $298 134%
Hfn Epo $179 - $340 152%
Multiplan Complementary Ntwrk $179 - $340 152%
Hfn Ppo - All Other Plans $197 - $374 168%
Oscar - All Plans $246 - $468 209%
Aetna $506 - $962 430%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15Th Street at California, Chicago, IL 60608
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals