CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Hillcrest Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $65
Cash Discount Price: $84
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Hillcrest Hospital is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.55x the Medicare baseline. Located in 6780 Mayfield Road, Mayfield Heights, OH.

Cash / Self-Pay

$84

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $84 (71%)

Insurance Median: $65 (55%)

Cash: $84 (71% of Medicare)

Ins. Median: $65 (55% 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
Blue Cross Blue Shield	$24 - $83	20%
Aetna	$28 - $129	24%
Oscar	$39 - $50	33%
Summacare	$39 - $48	33%
Cc Ehp	$50 - $51	43%
Aultcare	$54	46%
Amish Community Aid Plan	$58 - $64	49%
UnitedHealthcare	$58 - $80	49%
Ohcp	$63	54%
Paramount	$63	54%
Buckeye	$64	54%
Molina	$64	54%
Omas	$64	54%
Caresource	$66	56%
United	$66	56%
Amerihealth	$67	57%
Ohio Healthy	$70	60%
Healthsmart	$71	60%
Mmo	$74 - $76	63%
Php	$77	65%
The Health Plan	$77	65%
Upmc	$77	65%
Gms	$90	77%
Medical Benefit Corp	$90	77%
Quality Care Partners	$90	77%
Consociate Health	$97	83%
Managed Care Services	$97	83%
Humana	$110	94%
Frontpath	$116	99%
Multiplan	$116	99%
Tertiary Care Network	$116	99%
Three Rivers	$116	99%

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 $84.
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 Hillcrest 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.