CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $225
Cash Discount Price: $123
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Carilion Stonewall Jackson Hospital is $225. 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 1.91x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$225

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: $225 (191%)

Cash: $123 (105% of Medicare)

Ins. Median: $225 (191% 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	$86	73%
Sentara Health Plan	$88 - $217	75%
Abh of VA (Formerly Coventry)	$90	77%
Abh of Wva (Formerly Coventry)	$90	77%
Humana	$90	77%
UnitedHealthcare	$90 - $286	77%
Aetna	$178 - $232	151%
Gateway - Tier 3	$192	163%
Vhn - Ultra	$217	185%
Connecticare	$245	208%
Cigna	$280	238%
Gateway - Tier 2	$280	238%
Vhn - Plus	$280	238%
Integrated Health Plan	$298	253%
Vhn	$298	253%
Vhn - Link	$315	268%
Beech Street	$322	274%
Gateway - Tier 1	$332	282%
Vhn - Secondary Payors	$332	282%

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 Carilion Stonewall Jackson 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.