New patient office visit (30-44 min)
Facility: Lmh
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $301
- Cash Discount Price: $115
- vs. Medicare Baseline: 2.56x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 256% of the Medicare baseline (a markup of 156%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Blue Cross Blue Shield | $52 - $55 | 44% |
| Edw | $110 | 94% |
| Cigna | $264 - $308 | 225% |
| Aetna | $294 - $383 | 250% |
| UnitedHealthcare | $320 | 272% |
| Non Contracted | $369 | 314% |
| First Health | $429 | 365% |
Consumer Guidance & Cost Commentary
For this New patient office visit (30-44 min) at Lmh in Lawrence, KS, the facility's cash median rate of $115.00 is significantly lower than the state average, which is 2.6 times higher. While commercial insurers like Cigna and Aetna have negotiated rates ranging from $264 to $383, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket or utilizing prompt-pay discounts. It is important to note that the facility's negotiated rate of $301.00 is based on bulk contracts that include administrative overhead, whereas the Medicare benchmark of $117.57 serves as a more accurate baseline for the true cost of care.
Patients should verify their specific plan details before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if the insurer's allowed amount is high. Additionally, because the facility is a government-owned acute care hospital, asking about self-pay or prompt-pay discounts prior to check-in can bypass the costly insurance billing cycle, potentially reducing the bill by 20% to 50%. If you receive a bill, always request a full itemized statement to review CPT codes and ensure no services were unbundled or double-charged, as over 80% of hospital bills contain errors that can be corrected through a formal written audit.