New patient office visit (30-44 min)
Facility: Kiowa District Hospital
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $160
- Cash Discount Price: $120
- vs. Medicare Baseline: 1.36x 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 | $38 - $100 | 32% |
| Tricare | $66 - $275 | 56% |
| Humana | $68 - $275 | 58% |
| Triwest-All Plans | $68 - $275 | 58% |
| UnitedHealthcare | $68 - $275 | 58% |
| Medicaid / KanCare | $85 - $261 | 72% |
| Healthchoice-All Plans | $93 - $159 | 79% |
| Health Partners Of Ks-All Plans | $114 - $150 | 97% |
| Gbs Insurance - All Plans | $122 - $160 | 104% |
| Multiplan-All Plans | $122 - $160 | 104% |
| Medicare (plans) | $162 - $265 | 138% |
| Aetna | $162 - $275 | 138% |
| Providers Care (Wppa)-All Plans | $195 - $255 | 166% |
| Liberty Healthshare-All Plans | $275 - $467 | 234% |
Consumer Guidance & Cost Commentary
For a new patient office visit lasting 30 to 44 minutes at Kiowa District Hospital in Kiowa, Kansas, the billed amount is $150.00. While the facility's cash price is $120.00, commercial insurance negotiated rates typically range from $38.00 to $467.00 depending on the specific plan, with most major payers like UnitedHealthcare and Humana falling between $68.00 and $275.00. It is important to note that commercial negotiated rates often exceed the cash price due to administrative costs and contract structures; therefore, patients with high-deductible plans may find paying the $120.00 cash rate directly more cost-effective than relying on insurance, provided they have not yet met their deductible. Additionally, patients should inquire about "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the higher administrative fees associated with insurance claims processing.
This facility is a Critical Access Hospital with government ownership, and its pricing is benchmarked against federal standards. The Medicare allowed amount for this service is $117.57, which serves as a reliable baseline for evaluating fair pricing. Commercial negotiated rates generally average 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150% of this benchmark. The facility's median negotiated rate of $160.00 and median paid amount of $153.00 reflect the variability in payer contracts across the 14 insurance plans listed.