CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $116
Cash Discount Price: $141
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Munson Healthcare Otsego Memorial Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.99x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$141

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $141 (120%)

Insurance Median: $116 (99%)

Cash: $141 (120% of Medicare)

Ins. Median: $116 (99% 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
Mclaren Health Plan	$52 - $169	44%
Meridian	$52 - $59	44%
Molina	$52 - $122	44%
Priority Health	$52 - $192	44%
UnitedHealthcare	$52 - $161	44%
Blue Cross Blue Shield	$53 - $126	45%
Blue Care Network	$71 - $113	60%
Hap (Health Alliance Plan)	$71 - $161	60%
Humana	$71 - $113	60%
Medicare (plans)	$71 - $113	60%
Michigan Amish Medical Board	$71 - $113	60%
Northern Michigan Mennonite Group	$71 - $113	60%
Aetna	$72 - $163	61%
Hospice Of Michigan	$83 - $121	71%
Cigna	$93 - $192	79%
Munson Hospice	$97 - $852	83%
Asr Physicians Care Network	$107 - $161	91%
Enterprise Group Planning/Employee Benefit Plan	$111 - $161	94%
Nomi Health	$111 - $161	94%
Cofinity	$118 - $171	100%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$118 - $171	100%
Three Rivers Provider Network	$118 - $171	100%
Employee Benefit Logistics	$121 - $192	103%

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 $141.
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 Munson Healthcare Otsego Memorial 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.