CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Woodlawn Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $84
  • Cash Discount Price: $231
  • vs. Medicare Baseline: 0.71x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Woodlawn Hospital is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $231. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.71x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.
Cash / Self-Pay
$231

Average discount available for prompt cash payment at this facility.

Insurance Median
$84

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: $231 (196%)
Insurance Median: $84 (71%)
Cash: $231 (196% of Medicare)
Ins. Median: $84 (71% 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.

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 $65 - $280 55%
Blue Cross Blue Shield $65 - $295 55%
Caresource Mcaid Hip $65 55%
Caresource Mcr Adv $65 55%
Humana $65 - $229 55%
Mdwise Mcaid Excel Hip $65 - $68 55%
Mhs Exch Mrktplce-All Other Plans $65 - $68 55%
Mhs Mcaid Hip $65 - $68 55%
UnitedHealthcare $65 - $295 55%
Mhs Mcr Adv $66 56%
Phcs/Multiplan-All Plans $68 - $274 58%
Caresource Mcaid Hww $75 - $295 64%
Mdwise Excel Hhw & Hcc $77 65%
Mhs Mcaid Hcc $77 - $295 65%
Mhs Mcaid Hhw $77 - $295 65%
Encore Comm-All Plans $81 - $251 69%
Partners Direct Health-All Plans $81 - $201 69%
Caresource Exch - All Other Plans $84 - $85 71%
Ambetter / Centene $86 - $90 73%
Cigna $211 - $251 179%
Parkview Health Plans-All Plans $221 - $241 188%
Sagamore All Other Grps - All Other Plans $248 211%
Community Health Alliance-All Plans $280 238%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1400 E 9Th St, Rochester, IN 46975
  • CMS Rating: ★★★☆☆
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals