CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Anderson Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $215
Cash Discount Price: $172
vs. Medicare Baseline: 1.83x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Anderson Hospital is $215. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.83x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$215

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: $172 (146%)

Insurance Median: $215 (183%)

Cash: $172 (146% of Medicare)

Ins. Median: $215 (183% 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
Medicaid / KanCare	$42 - $220	36%
Work Comp	$97 - $26,600	83%
Health Care Service Corporation	$103 - $183	88%
Tricare	$108 - $50,000	92%
Humana	$116	99%
Medicare (plans)	$116 - $118	99%
UnitedHealthcare	$116 - $302	99%
Blue Choice	$146 - $22,500	124%
Self Pay	$162 - $25,000	138%
Blue Cross Blue Shield	$174 - $222	148%
Healthlink	$190 - $280	162%
Aetna	$192 - $236	163%
Mercy Benefit Admin	$206 - $260	175%
Cigna	$211 - $260	179%
Mercy Aco	$211 - $260	179%
Multiplan/Phcs	$244 - $300	208%
Beech Street Corporation	$292 - $360	248%

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 $172.
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 Anderson 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.