CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Portsmouth Regional Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $646
Cash Discount Price: $1,142
vs. Medicare Baseline: 5.49x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Portsmouth Regional Hospital is $646. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,142. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 5.49x the Medicare baseline. Located in 333 Borthwick Ave, Portsmouth, NH.

Cash / Self-Pay

$1,142

Average discount available for prompt cash payment at this facility.

Insurance Median

$646

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: $1,142 (971%)

Insurance Median: $646 (549%)

Cash: $1,142 (971% of Medicare)

Ins. Median: $646 (549% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 549% of the Medicare baseline (a markup of 449%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Amerihealth Caritas	$37 - $57	31%
Well Sense Health Plan	$74 - $112	63%
United	$234 - $907	199%
Maine Community Health	$285 - $728	242%
Tufts Health Plan	$342 - $786	291%
Aetna	$576 - $870	490%
Mvp Health Plan	$637 - $962	542%
Corvel	$655 - $989	557%
Evernorth	$728 - $1,099	619%
Mutual Of Omaha	$728 - $1,099	619%
Multiplan	$737 - $1,113	627%
First Health	$828 - $1,250	704%
Healthcare Value Mgmt	$828 - $1,250	704%
Oxford Health Plans	$864 - $1,305	735%
United Behavioral Health	$910 - $1,374	774%

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 $1,142.
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 Portsmouth Regional 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.