CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: St Joseph Health System, LLC

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $95
Cash Discount Price: $60
vs. Medicare Baseline: 0.81x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at St Joseph Health System, LLC is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.81x the Medicare baseline. Located in 702 Van Buren St., Fort Wayne, IN.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $60 (51%)

Insurance Median: $95 (81%)

Cash: $60 (51% of Medicare)

Ins. Median: $95 (81% 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
Amish Aid	$36 - $38	31%
Self Pay	$36 - $87	31%
Php	$37 - $64	31%
Lutheran Preferred	$42 - $95	36%
Php Freedom Network	$46 - $50	39%
Cigna	$48 - $159	41%
Blue Cross Blue Shield	$54 - $58	46%
Lutheran Network	$67 - $87	57%
Three Rivers	$67 - $72	57%
Aetna	$68 - $108	58%
Encore Ppo	$76 - $143	65%
Sagamore	$77 - $86	65%
Bccp In	$102	87%
Multiplan	$102 - $124	87%
Veterans Eval Services	$102	87%
First Health	$111 - $119	94%
Prime Health Services	$111 - $119	94%
Align Network	$118 - $127	100%
Frontpath Health Coalition	$118 - $127	100%
Advantage Health Solutions	$123 - $132	105%
Allied Benefit Systems	$133 - $143	113%
Medical Mutual Of Ohio	$148 - $159	126%
Parkview Healthplan Services	$148 - $159	126%
Value Options	$148 - $159	126%

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 $60.
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 Joseph Health System, LLC 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.