New patient office visit (30-44 min)
Facility: Wichita County Health Center
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $242
- Cash Discount Price: $116
- vs. Medicare Baseline: 2.06x 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 206% of the Medicare baseline (a markup of 106%). 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 |
|---|---|---|
| UnitedHealthcare | $145 | 123% |
| Medicaid / KanCare | $339 | 288% |
Consumer Guidance & Cost Commentary
For this new patient office visit at Wichita County Health Center in Leoti, Kansas, the cash price is $116.00, which is lower than the facility's gross charge of $145.00. While the facility is a Critical Access Hospital owned by the local government, the cash rate remains the most predictable cost for patients without insurance. It is important to note that commercial insurance plans often pay significantly more than cash prices due to administrative overhead and contract structures; for instance, the median negotiated rate for this service is $242.00. Patients with high-deductible plans should consider paying the cash price upfront, as this avoids the potential for high out-of-pocket costs if their insurance deductible has not yet been met. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
When comparing this facility's pricing to broader benchmarks, the cash rate of $116.00 is notably lower than the Medicare benchmark of $117.57, suggesting a fair price relative to the federal cost baseline. However, the facility's negotiated rate of $242.00 is substantially higher than the Medicare amount, illustrating how commercial contracts can inflate costs beyond the true cost of care. For patients relying on UnitedHealthcare or Medicaid/KanCare, the allowed amounts are fixed at $145.00 and $339.00 respectively, meaning the actual cost to the patient depends entirely on their specific plan's deductible and copay structure. To ensure you are not overcharged, always request an itemized bill that breaks down every CPT code and service rendered,