CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Johnson Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $245
Cash Discount Price: $250
vs. Medicare Baseline: 2.08x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Johnson Memorial Hospital is $245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $250. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 2.08x the Medicare baseline. Located in 1125 W Jefferson St, Franklin, IN.

Cash / Self-Pay

$250

Average discount available for prompt cash payment at this facility.

Insurance Median

$245

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: $250 (213%)

Insurance Median: $245 (208%)

Cash: $250 (213% of Medicare)

Ins. Median: $245 (208% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 208% of the Medicare baseline (a markup of 108%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$68 - $380	58%
Blue Cross Blue Shield	$68 - $481	58%
Cigna	$68 - $240	58%
Humana	$68 - $375	58%
Unified Group - All Plans	$200 - $291	170%
Encore - All Plans	$228 - $332	194%
UnitedHealthcare	$232 - $352	197%
Siho - All Plans	$298 - $433	253%
Multiplan - All Plans	$321 - $467	273%

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 $250.
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 Johnson Memorial 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.