New patient office visit (30-44 min)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $90
- Cash Discount Price: $104
- vs. Medicare Baseline: 0.77x 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 |
|---|---|---|
| Humana | $49 - $71 | 42% |
| Blue Cross Blue Shield | $52 - $138 | 44% |
| Tricare | $53 - $77 | 45% |
| Va Ccn - All Plans | $68 - $90 | 58% |
| Ambetter / Centene | $71 - $264 | 60% |
| UnitedHealthcare | $85 - $264 | 72% |
| Healthy Blue Mcaid - All Plans | $85 - $145 | 72% |
| Medicaid / KanCare | $85 - $264 | 72% |
| Aetna | $90 - $130 | 77% |
| Health Partners - All Plans | $95 - $138 | 81% |
Consumer Guidance & Cost Commentary
For the CPT code 99203 representing a new patient office visit lasting 30 to 44 minutes, Trego County Lemke Memorial Hospital in Wakeeney, KS, lists a gross charge of $123.00. While the facility's cash median rate is $104.00 and the median negotiated rate across ten payers is $90.00, these figures do not reflect the actual amount billed to most patients. Many commercial payers, including UnitedHealthcare and Ambetter/Centene, have negotiated rates that reach as high as $264.00, which can exceed the cash price. This dynamic is particularly relevant for patients with high-deductible plans, as paying the lower cash rate of $104.00 upfront may result in significant savings compared to the higher allowed amounts their insurance would otherwise pay.
To ensure you are not overcharged, it is critical to distinguish between the hospital's gross charges and the actual reimbursement rates. The facility's rates are benchmarked against Medicare, which sets a baseline of $117.57 for this service; commercial negotiated rates often sit higher due to administrative costs and contract structures. Patients should proactively request a prompt-pay discount if paying out-of-pocket, as hospitals frequently offer reductions for upfront payments to bypass costly insurance billing cycles. Additionally, if you receive a bill from an out-of-network provider at this in-network facility, you may be protected under the No Surprises Act, which prohibits balance billing for emergency and non-emergency services. Always verify your specific plan's deductible status and request an itemized bill to confirm that all charges align with the negotiated or cash rates before final