New patient office visit (30-44 min)
Facility: Memorial Hospital
Billing Code: 99203 (CPT)
- CPT Billing Code: 99203
- Insurance Median: $167
- Cash Discount Price: $195
- vs. Medicare Baseline: 1.42x 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 |
|---|---|---|
| Tricare | $59 - $170 | 50% |
| Medicare (plans) | $59 - $243 | 50% |
| Humana | $59 - $243 | 50% |
| Ambetter / Centene | $65 - $243 | 55% |
| Coventry - All Other Plans | $106 - $306 | 90% |
| Blue Cross Blue Shield | $107 | 91% |
| Health Partners Of Kansas - All Plans | $112 - $323 | 95% |
| Preferred Healthcare-All Plans | $112 - $323 | 95% |
| Wppa/Providers Care-All Plans | $165 - $476 | 140% |
Consumer Guidance & Cost Commentary
For a new patient office visit lasting 30 to 44 minutes at Memorial Hospital in Abilene, KS, the cash price is $195.00, which matches the facility's median negotiated rate of $167.00 and the cash median. While commercial payers like Tricare and Medicare have negotiated rates ranging from $59 to $243, the cash price remains the lowest option available for self-pay patients. Because commercial insurance often includes administrative overhead that inflates the baseline price by 20% to 40%, paying cash directly can sometimes be cheaper than using an in-network plan if your deductible has not yet been met. Patients should verify their specific plan's allowed amount before scheduling, as some in-network rates may exceed the cash price, making the out-of-pocket cost higher despite the insurance coverage.
The facility, a Critical Access Hospital owned by a Government Hospital District, bills at a rate 1.4 times the Medicare benchmark of $117.57, reflecting the standard markup found in commercial pricing structures. If you choose to use insurance, be aware that balance billing is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act, though unexpected charges can still occur for out-of-network ancillary services like emergency physicians or lab tests. To minimize costs, request a full itemized CPT-coded bill before paying, as summary bills often obscure errors or unbundled charges. Additionally, ask the billing department about prompt-pay discounts, which can reduce the total by 20% to 50% if you settle the account in full within 30 days, effectively bypassing the costly claims processing cycle that insurance billing requires