CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Fairview Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $179
Cash Discount Price: $262
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Fairview Hospital is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $262. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.52x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$262

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $262 (223%)

Insurance Median: $179 (152%)

Cash: $262 (223% of Medicare)

Ins. Median: $179 (152% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Blue Cross Blue Shield	$32 - $467	27%
Commcare Alliance	$32 - $210	27%
Fallon	$32 - $242	27%
Medicare (plans)	$32 - $211	27%
Other Government	$32 - $214	27%
Health New England	$33 - $412	28%
Hospice	$33 - $214	28%
UnitedHealthcare	$33 - $472	28%
Point32Health	$47 - $522	40%
Comm Fallon Qhp	$52 - $338	44%
Allways Nhp	$54 - $355	46%
Workers Comp	$54 - $350	46%
Aetna	$63 - $415	54%
Capital District Physicians' Health Plan	$76 - $494	65%
Cigna	$76 - $511	65%
Mvp	$76 - $494	65%
Oxford	$76 - $494	65%
First Health	$78 - $522	66%
Connecticare	$80 - $522	68%
Consolidated Health Plans	$80 - $522	68%
Other Commercial	$80 - $522	68%
Phcs	$80 - $522	68%
Self Pay	$80 - $522	68%
Comm Hne Hmo	$84 - $379	71%
Comm Hne Ppo	$84 - $402	71%
Unicare	$84 - $356	71%
Medicaid / KanCare	$412	350%
Bmchnp	$428	364%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $262.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fairview Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.