New patient office visit (30-44 min)
Facility: Smith County Memorial Hospital
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $208
- Cash Discount Price: $220
- vs. Medicare Baseline: 1.77x 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 |
|---|---|---|
| Blue Cross Blue Shield | $38 - $100 | 32% |
| Medicaid / KanCare | $154 - $249 | 131% |
| Multiplan-All Plans | $198 | 168% |
| Wppa-All Plans | $207 | 176% |
| Midlands Choice-All Plans | $209 | 178% |
| Health Partners Of Ks Ppo-All Plans | $209 | 178% |
| UnitedHealthcare | $209 | 178% |
Consumer Guidance & Cost Commentary
For this office visit at Smith County Memorial Hospital in Smith Center, Kansas, the cash price is $220.00, which matches the facility's median negotiated rate of $209.00 and the cash median. This cash rate is significantly lower than the typical negotiated rates seen with major payers like Blue Cross Blue Shield (ranging from $38 to $100) and Medicaid/KanCare ($154 to $249), though it is notably higher than the Medicare benchmark of $117.57. When compared to the state average, the cash price represents a 1.8x markup over Medicare, indicating that while the facility charges more than the federal baseline, the negotiated rates for commercial insurance plans often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find paying the $220.00 cash price directly more cost-effective than relying on insurance, which could result in higher out-of-pocket expenses if the allowed amount exceeds their deductible.
To ensure you receive the best possible rate, it is important to verify your specific insurance status before scheduling, as the facility's negotiated rates vary widely among the seven payers listed, ranging from a low of $38 to a high of $249. If you are self-pay, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if you have received a bill from this facility, request a detailed itemized audit to review every line item for errors, unbundled codes, or services not rendered,