New patient office visit (30-44 min)
Facility: Ellsworth County Medical Center
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $191
- Cash Discount Price: $213
- vs. Medicare Baseline: 1.62x 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 |
|---|---|---|
| Blue Cross Blue Shield | $36 - $100 | 31% |
| Va Ccn-All Plans | $110 - $258 | 94% |
| Triwest -All Plans | $110 - $258 | 94% |
| Healthy Blue Mcr Adv | $110 - $258 | 94% |
| Humana | $110 - $258 | 94% |
| UnitedHealthcare | $152 - $258 | 129% |
| First Health - All Plans | $172 - $211 | 146% |
| Aetna | $172 - $211 | 146% |
| Cigna | $181 - $222 | 154% |
| Healthy Blue Mcaid- All Other Plans | $191 - $234 | 162% |
| Medicaid / KanCare | $191 - $234 | 162% |
| Coventry Mcaid-All Plans | $191 - $234 | 162% |
| Providers Care-Wppa-All Plans | $286 - $351 | 243% |
Consumer Guidance & Cost Commentary
For this New patient office visit (30-44 min) at Ellsworth County Medical Center in Ellsworth, KS, the cash price is $213.00, which matches the facility's median paid amount of $211.00. While the facility is a Critical Access Hospital with a proprietary ownership structure, the cash rate is notably higher than the state average for this service code. Patients with high-deductible plans may find this cash price more affordable than their insurance negotiated rate, which averages $191.00 but often requires meeting a deductible first. It is important to note that while the facility offers a cash rate, commercial payers like Blue Cross Blue Shield and Humana have negotiated ranges starting as high as $110.00 and $152.00 respectively, meaning the cash price is not always the lowest option available.
Before scheduling, patients should verify their specific insurance status and ask the hospital directly about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid upfront. If you are using insurance, be aware that the No Surprises Act protects you from balance billing for out-of-network providers at in-network facilities, though you should still request an itemized bill to ensure no unbundled codes or services not rendered are included. Since over 80% of hospital bills contain errors, do not accept a summary bill as final; instead, request a detailed CPT-coded statement to identify any discrepancies. Finally, compare the facility's rates to the Medicare benchmark of $117.57; while commercial rates often exceed this baseline due to administrative costs, understanding the markup helps you