CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Elkhart General Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $130
Cash Discount Price: $132
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Elkhart General Hospital is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.11x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$132

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $132 (112%)

Insurance Median: $130 (111%)

Cash: $132 (112% of Medicare)

Ins. Median: $130 (111% 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
Devoted Healthcare	$20 - $61	17%
Blue Cross Blue Shield	$21 - $75	18%
Aetna	$45 - $207	38%
Cha	$60 - $239	51%
Immergrun	$60 - $245	51%
Mhs	$65 - $398	55%
Php	$65 - $214	55%
UnitedHealthcare	$67 - $206	57%
Humana	$69 - $214	59%
Cigna	$72 - $233	61%
Multiplan	$72 - $220	61%
Signature	$73 - $223	62%
Encore	$74 - $226	63%
Plain Church	$80 - $245	68%
Heartland	$100 - $306	85%
Caresource	$130 - $398	111%
Mdwise	$130 - $398	111%

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 $132.
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 Elkhart General 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.