New patient office visit (30-44 min)
Facility: Providence Medical Center
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $106
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.90x 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 |
|---|---|---|
| Early Detection Works | $106 | 90% |
Consumer Guidance & Cost Commentary
For this office visit at Providence Medical Center in Kansas City, the negotiated rate of $106.00 is the amount your insurance plan, Early Detection Works, will pay. This figure represents the contractual ceiling for in-network care and is significantly lower than the facility's gross charge of $564.00, which is the full list price before any discounts. While the data does not provide a specific cash or self-pay median, patients with high-deductible plans or those without insurance may find that paying the full negotiated rate of $106.00 upfront is more cost-effective than waiting for insurance to process a claim, especially if their deductible is not yet met. It is always advisable to contact the hospital directly to confirm if a "self-pay" or "prompt-pay" discount is available for immediate settlement, as these programs can further reduce the final amount owed.
This service is benchmarked against the Medicare rate of $117.57, which serves as a scientifically validated baseline for the true cost of care in this region. The negotiated rate of $106.00 is slightly below the Medicare amount, indicating a favorable pricing structure compared to the federal standard. Although the data does not list specific state or county average comparisons for this specific CPT code, the facility's ownership as a voluntary non-profit church organization often influences its pricing strategy to remain competitive within the local market. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to verify network status before scheduling to avoid unexpected charges. If you receive a bill that exceeds the allowed amount, you should request an itemized audit to identify any unbund