New patient office visit (30-44 min)
Facility: Holton Community Hospital
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $134
- Cash Discount Price: $164
- vs. Medicare Baseline: 1.14x 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 |
|---|---|---|
| UnitedHealthcare | $62 - $585 | 53% |
| Aetna | $76 - $585 | 65% |
| Humana | $76 - $313 | 65% |
| Kansas Superior Select - All Plans | $77 - $316 | 65% |
| Medicaid / KanCare | $85 - $585 | 72% |
| Blue Cross Blue Shield | $100 | 85% |
| Preferred Health Professionals | $118 - $486 | 100% |
| Preferred Health Freedom | $118 - $486 | 100% |
| Preferred Health Fn Select - All Other Plans | $118 - $486 | 100% |
| Wppa Providers - All Plans | $135 - $556 | 115% |
Consumer Guidance & Cost Commentary
For this New patient office visit (30-44 min) at Holton Community Hospital in Kansas, the cash price of $164.00 is notably higher than the state average of $100.00, though it remains below the gross charge of $219.00. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $62 to $585, these negotiated amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find paying the cash rate directly more cost-effective than relying on insurance, as the insurer's allowed amount could be significantly higher than the facility's self-pay price.
To minimize costs, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront. Although the facility is a Critical Access Hospital in a Voluntary non-profit setting, patients should verify their specific plan's negotiated rate before scheduling, as in-network rates vary widely across payers. If you receive a bill, always request a detailed itemized statement to review every code and ensure no services were rendered or bundled incorrectly, as over 80% of hospital bills contain errors that can be disputed.