CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: St Claire Regional Medical Center

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $113
  • Cash Discount Price: $135
  • vs. Medicare Baseline: 0.96x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at St Claire Regional Medical Center is $113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $135. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.96x the Medicare baseline. Located in 222 Medical Circle, Morehead, KY.
Cash / Self-Pay
$135

Average discount available for prompt cash payment at this facility.

Insurance Median
$113

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $135 (115%)
Insurance Median: $113 (96%)
Cash: $135 (115% of Medicare)
Ins. Median: $113 (96% of 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.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Wellcare Mcaid $31 - $387 26%
Medicaid / KanCare $33 - $379 28%
Aetna $61 - $379 52%
Beacon Bh - All Plans $64 54%
Blue Cross Blue Shield $70 - $273 60%
Caresource Mcr Adv $70 60%
Humana $70 - $265 60%
Healthlink - All Plans $74 - $263 63%
Wellcare Comm - All Other Plans $87 - $322 74%
Caresource Just4Me - All Other Plans $90 - $97 77%
Ky Health Co-Op - All Plans $90 - $493 77%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 222 Medical Circle, Morehead, KY 40351
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Federal
  • Hospital Type: Acute Care Hospitals