New patient office visit (30-44 min)
Facility: Hiawatha Community Hospital
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $268
- Cash Discount Price: $298
- vs. Medicare Baseline: 2.28x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 228% of the Medicare baseline (a markup of 128%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $96 - $101 | 82% |
| Centrus Health Direct - All Plans | $212 - $237 | 180% |
| Oscar - All Plans | $212 - $237 | 180% |
| Aetna | $228 - $257 | 194% |
| Preferred Hlth - All Plans | $254 - $284 | 216% |
| Humana | $257 | 219% |
| Wppa Providrs Care - All Plans | $268 - $300 | 228% |
| Cigna | $268 - $300 | 228% |
| Ambetter / Centene | $270 | 230% |
| Midlands Choice - All Plans | $274 - $307 | 233% |
| Multiplan - All Plans | $274 - $307 | 233% |
| Healthy Blue Mcaid - All Plans | $282 - $316 | 240% |
Consumer Guidance & Cost Commentary
For a new patient office visit lasting 30 to 44 minutes at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $298.00. This cash rate is identical to the facility's median negotiated rate of $271.00, which is notably higher than the state average of $268.00. While commercial insurance plans typically pay between $96 and $316 depending on the carrier, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance negotiated rate exceeds $298.00. It is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly even within the same facility.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront. Although the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, it is crucial to request a full itemized bill before paying to ensure no errors or unbundled charges are included. For context, the facility's Medicare benchmark rate for this service is $117.57, indicating that commercial rates are substantially higher than the federal baseline. Given the facility's location in a Critical Access Hospital network, comparing these specific rates to the local county averages provides a clearer picture of fair pricing than relying on the hospital's full chargemaster list.