New patient office visit (30-44 min)
Facility: Kansas City Orthopaedic Institute
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $300
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.55x 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 255% of the Medicare baseline (a markup of 155%). 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 |
|---|---|---|
| Cigna | $209 | 178% |
| UnitedHealthcare | $263 | 224% |
| Blue Cross Blue Shield | $268 - $300 | 228% |
| Medica | $340 | 289% |
Consumer Guidance & Cost Commentary
For this New patient office visit (30-44 min) at the Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rates range from $209 to $340 depending on your specific insurance plan, with a median negotiated rate of $300.00. While the facility is a Physician-owned Acute Care Hospital, the data indicates no available cash-pay or median paid rates for this service, meaning patients relying on out-of-pocket payment may not be able to access the potential savings of a cash discount unless the facility explicitly offers a self-pay or prompt-pay rate. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and insurance contract structures; however, without a listed cash median, the financial advantage of paying upfront cannot be confirmed for this specific code.
When evaluating the cost relative to the broader market, the facility's gross charge of $419.00 serves as the baseline, but the actual amount billed to an insured patient will vary based on the payer's contract. For instance, Cigna and UnitedHealthcare have fixed negotiated rates of $209 and $263 respectively, while Blue Cross Blue Shield offers a range up to $300 across six plans, and Medica charges $340. The Medicare benchmark for this service is $117.57, which acts as a critical reference point to understand the markup inherent in commercial pricing. Since the data does not provide specific county or state average comparisons for this exact procedure, patients should verify their specific plan's allowed amount directly with the billing department before scheduling to ensure they are aware of their out-of-pocket responsibility.