CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: North Adams Regional Hospital Corporation

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $161
  • Cash Discount Price: $262
  • vs. Medicare Baseline: 1.37x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at North Adams Regional Hospital Corporation is $161. 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 1.37x the Medicare baseline. Located in 71 Hospital Avenue, North Adams, MA.
Cash / Self-Pay
$262

Average discount available for prompt cash payment at this facility.

Insurance Median
$161

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: $161 (137%)
Cash: $262 (223% of Medicare)
Ins. Median: $161 (137% 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
Blue Cross Blue Shield $19 - $467 16%
Comm Hospice $19 - $126 16%
McR Miscellaneous $19 - $126 16%
McRmanaged Cca One Care $19 - $136 16%
McRmanaged USA Family $19 - $126 16%
McRmanaged VA $19 - $126 16%
Medicaid / KanCare $19 - $412 16%
Medicare (plans) $19 - $148 16%
Oth United Vaccn $19 - $126 16%
Tricare $32 - $206 27%
Comm Network Qhpsub $47 - $332 40%
McDmanaged Network $47 - $335 40%
Comm Fallon Qhp $48 - $311 41%
Wc Workers Comp $51 - $333 43%
Comm Network Qhpnonsub $54 - $395 46%
Comm Nhp $54 - $355 46%
Aetna $63 - $415 54%
Comm Tufts $67 - $435 57%
UnitedHealthcare $72 - $472 61%
Cigna $76 - $511 65%
Comm Cdphp $76 - $494 65%
Comm Mvp $76 - $494 65%
Comm Oxford $76 - $494 65%
Comm First Health $78 - $522 66%
Comm Connecticare $80 - $522 68%
Comm Consolidated Health $80 - $522 68%
Comm Other $80 - $522 68%
Comm PHCS $80 - $522 68%
Comm Self Pay $80 - $522 68%
Comm Hne $84 - $401 71%
Comm Hne HMO $84 - $379 71%
Comm Hne PPO $84 - $402 71%
Comm Unicare $84 - $356 71%
Comm Harvard $103 - $522 88%
McD New York $204 174%
McD Masshealth $412 350%
McD Out of State $412 350%
McDmanaged Cdphp $412 350%
McDmanaged Hne McDaco $412 350%
McDmanaged Bmchnp $428 364%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 71 Hospital Avenue, North Adams, MA 01247
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Federal
  • Hospital Type: Critical Access Hospitals