CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Rio Grande Regional Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $89
Cash Discount Price: $198
vs. Medicare Baseline: 0.76x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Rio Grande Regional Hospital is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.76x the Medicare baseline. Located in 101 E Ridge Rd, McAllen, TX.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $198 (168%)

Insurance Median: $89 (76%)

Cash: $198 (168% of Medicare)

Ins. Median: $89 (76% 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
Superior Health Plan	$13 - $19	11%
Superior	$33 - $47	28%
United	$33 - $122	28%
Texas Workforce Commission	$45 - $65	38%
Healthcare Highways	$47 - $69	40%
Aetna	$49 - $125	42%
Molina Healthcare	$50 - $73	43%
Averde Health	$61 - $89	52%
Allegian Health	$74 - $108	63%
Curative Administrators	$74 - $108	63%
Healthsmart Preferred Care	$80 - $230	68%
Blue Cross Blue Shield	$84 - $452	71%
First Health	$107 - $156	91%
National Healthcare Solutions	$112 - $163	95%
Southwest Medical	$112 - $163	95%
Coastal Comp	$121 - $176	103%
Usa Managed Care	$121 - $217	103%
Ppo Next/ Medical Control	$139 - $203	118%
Beech Street	$149 - $217	127%
Multiplan	$149 - $217	127%
Focus Healthcare	$177 - $257	151%
Texas Athletic Network	$300 - $600	255%
Humana	$405	344%

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 $198.
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 Rio Grande 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.