CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Kosciusko Community Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $94
Cash Discount Price: $49
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Kosciusko Community Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.80x the Medicare baseline. Located in 2101 E Dubois Dr, Warsaw, IN.

Cash / Self-Pay

$49

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $49 (42%)

Insurance Median: $94 (80%)

Cash: $49 (42% of Medicare)

Ins. Median: $94 (80% 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	$31 - $40	26%
Self Pay	$31 - $74	26%
Lutheran Preferred Network	$47 - $151	40%
Physicians Health Plan	$55 - $87	47%
Php Freedom Network	$57 - $73	48%
UnitedHealthcare	$58 - $95	49%
Encore	$59 - $76	50%
Trma Inc	$59 - $85	50%
Aetna	$61 - $101	52%
One Call Care Diagnostics Wc	$68	58%
Connecticut General Life Insurance Company	$87 - $111	74%
Cigna	$94 - $119	80%
Indiana Breast & Cervical Cancer Program	$102	87%
Veterans Eval Services	$102	87%
First Health Network	$111 - $142	94%
Prime Health Services	$111 - $142	94%
Advantage Health	$123 - $157	105%
Private Healthcare Systems	$127 - $163	108%
Sagamore	$130 - $178	111%
Encore Health Network	$138 - $176	117%

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 $49.
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 Kosciusko Community 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.