CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Sweeny Community Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $205
Cash Discount Price: $123
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Sweeny Community Hospital is $205. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.74x the Medicare baseline. Located in 305 North McKinney, Sweeny, TX.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$205

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: $123 (105%)

Insurance Median: $205 (174%)

Cash: $123 (105% of Medicare)

Ins. Median: $205 (174% 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	$50 - $271	43%
Aetna	$54 - $434	46%
Evercare Mcaid	$83 - $271	71%
UnitedHealthcare	$90 - $434	77%
Amerigroup Mcr Adv - All Other Plans	$97 - $315	83%
Community Hlth Choice Him - All Other Plans	$97 - $315	83%
Coventry Mcr Adv	$97 - $315	83%
Molina Mcr Adv - All Other Plans	$97 - $315	83%
Superior Hp Mcr Adv-All Other Plans	$97 - $315	83%
Wellcare Mcare - All Plans	$97 - $315	83%
Care Improvement Mcr - All Plans	$98 - $318	83%
Choicecare Mcr Adv - All Plans	$98 - $318	83%
Community Hlth Choice Star	$118 - $383	100%
Molina Mcaid	$118 - $383	100%
Superior Hp Mcaid	$118 - $383	100%
Tx Chlidrens Hp Mcaid - All Plans	$118 - $383	100%
Tx True Choice Mcaid - All Plans	$118 - $383	100%
Beech Street - All Plans	$125 - $407	106%
Community Care Network - All Plans	$133 - $434	113%
Galaxy Health Network - All Plans	$150 - $489	128%
Multiplan - All Plans	$150 - $489	128%
Evercare Mcr Adv - All Other Plans	$162 - $527	138%
Amerigroup Mcaid	$167 - $543	142%

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 $123.
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 Sweeny Community 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.