CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Pulaski Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $132
Cash Discount Price: $180
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Pulaski Memorial Hospital is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $180. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.12x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$180

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $180 (153%)

Insurance Median: $132 (112%)

Cash: $180 (153% of Medicare)

Ins. Median: $132 (112% 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
Ambetter / Centene	$68 - $132	58%
Blue Cross Blue Shield	$68 - $426	58%
Caresource Mcaid Hip	$68 - $132	58%
Cenpatico Mcaid Hip	$68 - $132	58%
Mhs Mcaid Hip	$68 - $132	58%
Multiplan - All Plans	$68 - $384	58%
UnitedHealthcare	$68 - $426	58%
Cigna	$69 - $405	59%
Humana	$69 - $343	59%
Sagamore - All Other Plans	$69 - $322	59%
Sagamore Rose Acre	$69 - $318	59%
Caresource Mcaid Hhw	$75 - $426	64%
Cenpatico Mcaid Hhw - All Other Plans	$75 - $426	64%
Mdwise Mcaid Hcc	$75 - $426	64%
Mdwise Mcaid Hhw	$75 - $426	64%
Mdwise Mcaid Hip - All Other Plans	$75 - $132	64%
Mhs Mcaid Hhw/Hcc	$75 - $426	64%
Caresource Mcare Hmo	$80 - $132	68%
Encore Ppo - All Other Plans	$81 - $363	69%
Mhs Mcare Allwell	$81 - $134	69%
Caresource Exch Hmo Hix - All Other Plans	$85 - $165	72%
Aetna	$93 - $154	79%
Encore Workers Comp	$130 - $384	111%
Community Health Alliance - All Plans	$136 - $380	116%

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 $180.
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 Pulaski 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.