New patient office visit (30-44 min)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $141
- Cash Discount Price: $145
- vs. Medicare Baseline: 1.20x 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 |
|---|---|---|
| Tricare | $116 - $164 | 99% |
| Humana | $132 - $187 | 112% |
| Aetna | $134 - $183 | 114% |
| UnitedHealthcare | $138 | 117% |
| Hpk-All Plans | $138 | 117% |
| Medicaid / KanCare | $145 - $187 | 123% |
Consumer Guidance & Cost Commentary
For this office visit at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $145.00, which matches the facility's median negotiated rate and the state average. While the hospital is a Critical Access Hospital owned by a Government Hospital District, the data shows no specific county or state average provided for comparison. It is important to note that for patients with high-deductible plans, paying the cash price of $145.00 upfront can sometimes be cheaper than the insurance negotiated rate, which ranges from $116 to $187 depending on the payer. Commercial payers like Aetna and Humana have negotiated rates that can exceed the cash price, meaning self-pay patients might save money by requesting a prompt-pay discount before scheduling.
Patients should verify if the hospital offers a prompt-pay discount, which can reduce the bill by 20% to 50% if paid in full within 30 days, effectively bypassing the administrative costs of insurance claims processing. Since the facility is in-network for all listed payers, balance billing is not a concern for this specific service under the No Surprises Act. However, consumers should always request an itemized bill to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. When reviewing the final statement, compare the total charged against the Medicare amount of $117.57 to understand the markup, as fair pricing is typically defined as 120% to 150% of this federal baseline.