CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Hospital for Special Surgery

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $326
Cash Discount Price: $495
vs. Medicare Baseline: 2.77x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Hospital for Special Surgery is $326. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $495. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 2.77x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$495

Average discount available for prompt cash payment at this facility.

Insurance Median

$326

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: $495 (421%)

Insurance Median: $326 (277%)

Cash: $495 (421% of Medicare)

Ins. Median: $326 (277% 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 277% of the Medicare baseline (a markup of 177%). 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
Metro Plus	$41 - $125	35%
Fidelis	$60 - $120	51%
Emblem	$80 - $235	68%
UnitedHealthcare	$80 - $440	68%
Blue Cross Blue Shield	$128 - $440	109%
Cigna	$159 - $296	135%
Aetna	$171 - $440	145%
Nyship	$173 - $237	147%
Horizon	$230	196%
Apwu [1016]	$266 - $296	226%
Nalc [1090]	$266 - $296	226%
Qualcare [1101]	$266 - $296	226%
Wellfleet [1361]	$266 - $296	226%
Christian Brothers [1034]	$326 - $440	277%
Meritain Health [1085]	$326 - $440	277%
Nippon Life [1092]	$326 - $440	277%
Webtpa [1356]	$326 - $440	277%
Affinity By Molina Health Plan [1005]	$330 - $440	281%
Connecticare [1039]	$330 - $440	281%
Emblem Health [1043]	$330 - $440	281%
Fidelis Essential [1323]	$440	374%
Geha [1053]	$440	374%
Harvard Pilgrim [1057]	$440	374%
Medicare (plans)	$440	374%
Oxford [1096]	$440	374%
Student Resources [1103]	$440	374%

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 $495.
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 Hospital for Special Surgery 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.