New patient office visit (30-44 min)
Facility: Rooks County Health Center
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $79
- Cash Discount Price: $175
- vs. Medicare Baseline: 0.67x 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 |
|---|---|---|
| Veterans Admin - All Plans | $68 | 58% |
| Tricare | $68 | 58% |
| Celtic Comm - All Other Plans | $71 | 60% |
| UnitedHealthcare | $78 | 66% |
| Preferred Hlthcare - All Other Plans | $79 | 67% |
| Preferred Benefits Admin | $79 | 67% |
| Healthy Blue Mcaid - All Plans | $85 | 72% |
| Blue Cross Blue Shield | $103 | 88% |
| Aetna | $110 | 94% |
| Health Partners - All Plans | $139 | 118% |
Consumer Guidance & Cost Commentary
For CPT code 99203, representing a new patient office visit lasting 30 to 44 minutes, the gross charge at Rooks County Health Center in Plainville, KS, is $234.00. This facility, a Critical Access Hospital owned by a government hospital district, has a cash median price of $175.00, which is lower than the gross charge. When compared to the Medicare benchmark of $117.57, the cash price represents a markup of approximately 149%, falling within the range often considered fair pricing (120% to 150% of Medicare). The facility's negotiated rates vary significantly by payer, ranging from a low of $68.00 with Veterans Admin and Tricare to a high of $139.00 with Health Partners. These negotiated amounts are generally higher than the cash price, illustrating that for patients with high-deductible plans or those without insurance, paying the cash median of $175.00 upfront may result in lower out-of-pocket costs than relying on insurance, which often includes administrative overhead and deductible requirements.
Patients should be aware that while the facility offers a median negotiated rate of $79.00 across payers, this does not guarantee the lowest possible cost for every individual plan, as rates are contractually set ceilings that can exceed cash prices. To maximize savings, individuals should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service. Since over 80% of hospital bills