CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Glens Falls Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $105
Cash Discount Price: $126
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Glens Falls Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.89x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $126 (107%)

Insurance Median: $105 (89%)

Cash: $126 (107% of Medicare)

Ins. Median: $105 (89% 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
Medicaid / KanCare	$29 - $100	25%
Cdphp	$30 - $171	26%
Medicare (plans)	$58 - $105	49%
UnitedHealthcare	$58 - $147	49%
Emblem Health Ghi	$65 - $105	55%
Tricare	$65 - $105	55%
Mvp	$67 - $179	57%
Aetna	$75 - $140	64%
Fidelis	$77 - $173	65%
Blue Cross Blue Shield	$88 - $187	75%
Cigna	$105 - $179	89%
Blue Shield	$109 - $297	93%
Blue Shield Highmark	$109 - $132	93%
Hamaspik	$140 - $187	119%
Nascentia Health Options	$140 - $187	119%
Magnacare	$162 - $216	138%
Emblem	$173 - $230	147%
Empire Plan Nyship	$184 - $245	157%
Multiplan	$184 - $245	157%
Mvp Commercial	$391 - $422	333%

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 $126.
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 Glens Falls 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.