New patient office visit (30-44 min)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $138
- Cash Discount Price: $115
- vs. Medicare Baseline: 1.17x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $43 - $127 | 37% |
| Medica Contracted [320239] | $63 - $74 | 54% |
| Humana | $73 - $98 | 62% |
| Cross Timbers Hospice [20098] | $73 | 62% |
| Halo Hcr Inc Hospice Contracted [320432] | $73 | 62% |
| Dept Of Veteran Affairs Contracted [320106] | $73 | 62% |
| Blue Cross Blue Shield | $73 - $122 | 62% |
| Elara Caring Aspire Hospice [20433] | $73 | 62% |
| Kindful Hospice [20434] | $73 | 62% |
| Kindful Hospice Contracted [320434] | $73 | 62% |
| Halo Hcr Inc Hospice [20432] | $73 | 62% |
| Mercy Hospice Okc [20252] | $73 | 62% |
| Medicare (plans) | $73 - $75 | 62% |
| Aetna | $73 - $172 | 62% |
| Pace Of The Ozarks Contracted [320518] | $73 | 62% |
| Tricare | $75 | 64% |
| UnitedHealthcare | $76 - $136 | 65% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $77 | 65% |
| United Medical Resources Contracted [320454] | $116 - $136 | 99% |
| Cigna | $119 - $156 | 101% |
| Home State Health Plan Contracted [320187] | $127 | 108% |
| Ambetter / Centene | $127 | 108% |
| Workers Comp [20426] | $138 - $162 | 117% |
| American Healthcare Alliance Contracted [320020] | $138 - $162 | 117% |
| Reflect Health Contracted [320492] | $138 - $162 | 117% |
| Auxiant Contracted [320462] | $138 - $162 | 117% |
| Yuzu Health Contracted [320521] | $138 - $162 | 117% |
| Ebms Contracted [320493] | $138 - $162 | 117% |
| Edison Health Solutions Contracted [320502] | $138 - $162 | 117% |
| Aither Health Contracted [320449] | $138 - $162 | 117% |
| Mercy Benefit Admin Contracted [320251] | $138 - $162 | 117% |
| Healthlink Contracted [320179] | $138 - $162 | 117% |
| Imagine 360 Contracted [320494] | $138 - $162 | 117% |
| Providrs Care Network Contracted [320484] | $142 | 121% |
| First Health Contracted [320128] | $146 - $172 | 124% |
| Health Choice Contracted [320166] | $171 | 145% |
Consumer Guidance & Cost Commentary
For a new patient office visit lasting 30 to 44 minutes, Mercy Hospital Pittsburg, Inc. lists a gross charge of $177.00, though actual payment varies significantly by payer. While the facility's cash median is $115.00, commercial insurance plans negotiate rates ranging from $43 to $172, with the median negotiated rate across all payers sitting at $138.00. This means that for many insured patients, paying out-of-pocket cash upfront could result in a lower total cost than relying on insurance, as the cash price is often below the insurer's allowed amount. Given that the facility is a voluntary non-profit church-owned acute care hospital in Pittsburg, KS (zip 66762), patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative overhead and higher negotiated rates associated with insurance billing.
It is important to note that while the facility's cash rate of $115.00 is lower than the commercial median, it is still 20% higher than the Medicare benchmark of $117.57, indicating that the facility's pricing structure is based on a markup relative to federal cost standards rather than the cash price alone. Patients should be aware that balance billing is generally prohibited for emergency services and non-emergency care at in-network facilities under the No Surprises Act, but unexpected charges can still occur if ancillary services like labs or emergency physicians are out-of-network. To avoid surprise costs, consumers should request a full itemized bill before paying and verify that all services rendered match the charges listed, as over 8