CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Prosser Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $132
Cash Discount Price: $180
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Prosser Memorial Hospital is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $180. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.12x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$180

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $180 (153%)

Insurance Median: $132 (112%)

Cash: $180 (153% of Medicare)

Ins. Median: $132 (112% 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
Community Health Plan Of Washington	$37 - $132	31%
Coordinated Care	$37 - $132	31%
Kaiser Permanente	$37 - $434	31%
UnitedHealthcare	$37 - $313	31%
Amerigroup	$39 - $460	33%
Molina	$39 - $132	33%
Multiplan	$60 - $313	51%
Health Alliance Northwest	$82 - $313	70%
Wellcare	$82 - $313	70%
Humana	$83 - $278	71%
Cigna	$90 - $268	77%
Aetna	$92 - $341	78%
Premera	$105 - $262	89%
Asuris	$108 - $294	92%
Health Management Adminstrators	$108 - $294	92%
Regence	$108 - $294	92%
Ambetter / Centene	$165 - $564	140%
First Choice	$278	236%

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 $180.
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 Prosser Memorial 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.