CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Pocahontas Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $119
Cash Discount Price: $154
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Pocahontas Memorial Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.01x the Medicare baseline. Located in 150 Duncan Road, Buckeye, WV.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $154 (131%)

Insurance Median: $119 (101%)

Cash: $154 (131% of Medicare)

Ins. Median: $119 (101% 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
Aetna	$20 - $201	17%
Unicare Health Plan of Wv, Inc. - Commercial-Hmo	$20	17%
Wellpoint West Virginia, Inc. - Commercial-Hmo	$20	17%
Medicaid / KanCare	$20	17%
Medicare (plans)	$86 - $127	73%
Highmark Senior Solutions Company - Commercial-Ppo	$123	105%
Humana	$125	106%
Wv Treasury Peia - Commercial-Ppo	$127	108%
UnitedHealthcare	$129 - $157	110%
Blue Cross Blue Shield	$143	122%

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 $154.
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 Pocahontas 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.