New patient office visit (30-44 min)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $102
- Cash Discount Price: $230
- vs. Medicare Baseline: 0.87x 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 |
|---|---|---|
| Aetna | $68 - $184 | 58% |
| UnitedHealthcare | $80 - $265 | 68% |
| Blue Cross Blue Shield | $101 - $103 | 86% |
Consumer Guidance & Cost Commentary
For a new patient office visit lasting 30 to 44 minutes at Community Memorial Healthcare in Marysville, Kansas, the cash price is $230.00, which matches the facility's median paid amount. While the facility's negotiated rates with major payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield range from $68 to $265, the cash price can sometimes be more affordable for patients with high-deductible plans if their insurance negotiated rate exceeds this amount. It is important to note that commercial rates often include administrative overhead and contract dynamics that can inflate the baseline price, so patients should verify their specific plan's allowed amount before scheduling. Additionally, patients should check with the hospital for potential "self-pay" or "prompt-pay" discounts, which can reduce the final bill by offering immediate liquidity incentives that bypass costly claims processing.
This service is benchmarked against the federal Medicare rate of $117.57, where the cash price represents a 90% relative value compared to Medicare, indicating a markup typical of commercial pricing structures. While the data does not provide specific county or state average comparisons for this specific CPT code, the facility operates as a Critical Access Hospital with a voluntary non-profit ownership structure, which often influences pricing transparency. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected ancillary services from out-of-network providers could still trigger additional charges. To avoid errors, patients should request a full itemized bill before paying, ensuring no unbundled codes or services not rendered are included in the final invoice.