CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: St John's Riverside Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $82
Cash Discount Price: $471
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at St John's Riverside Hospital is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $471. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.70x the Medicare baseline. Located in 976 North Broadway, Yonkers, NY.

Cash / Self-Pay

$471

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $471 (401%)

Insurance Median: $82 (70%)

Cash: $471 (401% of Medicare)

Ins. Median: $82 (70% 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
Fidelis Essential Plans	$70	60%
Medicaid / KanCare	$70	60%
Fidelis Health Benefit Exchange	$78	66%
Aetna	$82 - $3,783	70%
Centers Plan For Healthy Living	$82	70%
Fidelis	$82	70%
Healthfirst	$82	70%
Hip Health Plan	$82	70%
Magnacare	$82	70%
Medicare (plans)	$82	70%
Mvp	$82	70%
Mvp Bhs	$82	70%
Oscar	$82 - $86	70%
Partners Health Plan	$82	70%
United Behavioral Health Of Ny Ipa	$82	70%
Village Caremax	$82	70%
Wellcare	$82	70%
Metroplus Gold	$86	73%
Blue Cross Blue Shield	$103	88%
Empire Hmo	$103	88%
UnitedHealthcare	$135	115%
Cigna	$202 - $620	172%
Emblem Health	$208	177%
Mvp Individual Exchange.Student Health Plan	$288	245%
Mvp Commercial	$340	289%

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 $471.
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 St John's Riverside 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.