New patient office visit (30-44 min)
Facility: St Luke Hospital & Living Center
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $59
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.50x 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 | $28 - $197 | 24% |
| Humana | $28 - $197 | 24% |
| UnitedHealthcare | $28 - $197 | 24% |
| Ambetter / Centene | $28 - $199 | 24% |
| Bluestem Pace | $28 - $197 | 24% |
| Kansas Department Of Health And Environment | $28 - $197 | 24% |
| Va Ccn | $28 - $197 | 24% |
Consumer Guidance & Cost Commentary
For the CPT code 99203 representing a new patient office visit lasting 30 to 44 minutes, St Luke Hospital & Living Center in Marion, KS, lists a gross charge of $115.00. This facility is a Critical Access Hospital owned by a Government Hospital District, and its negotiated rates average $59.00, which is significantly lower than the state average for this service. While the facility's gross charge is higher than the Medicare benchmark of $117.57, it is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. Patients with high-deductible plans should be aware that paying cash directly might result in a lower out-of-pocket cost if the insurance negotiated rate exceeds the cash price, though the facility does not currently list a specific cash median.
To ensure you are receiving the most accurate pricing, it is recommended to request a full itemized bill before finalizing payment, as summary bills can obscure individual line items and potential errors. If you choose to pay out-of-pocket, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total by 20% to 50% if settled within a short window. Additionally, verify your insurance status before scheduling, as assuming that being in-network guarantees the lowest possible rate can lead to unexpected costs if your specific plan has different negotiated allowances. Always check with the hospital directly for any available discounts or payment plans tailored to your situation.