CMS Price Transparency Data
New patient office visit (30-44 min)
Facility: Wooster Community Hospital
Billing Code: 99203 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99203
- Insurance Median: $158
- Cash Discount Price: $187
- vs. Medicare Baseline: 1.34x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Wooster Community Hospital is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $187. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.34x the Medicare baseline. Located in 1761 Beall Avenue, Wooster, OH.
Cash / Self-Pay
$187
Average discount available for prompt cash payment at this facility.
Insurance Median
$158
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: $187 (159%)
Insurance Median: $158 (134%)
Cash: $187 (159% of Medicare)
Ins. Median: $158 (134% 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.
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 |
|---|---|---|
| Buckeye Mcaid-All Other Plans | $60 | 51% |
| Caresource Mcaid | $60 | 51% |
| UnitedHealthcare | $60 - $182 | 51% |
| Molina Mcaid | $61 | 52% |
| Blue Cross Blue Shield | $62 - $177 | 53% |
| Aetna | $63 - $192 | 54% |
| Amerihealth Mcaid-All Plans | $63 | 54% |
| Tricare | $69 | 59% |
| Buckeye Mcare | $70 | 60% |
| Caresource Mcr Adv | $70 | 60% |
| Humana | $70 - $180 | 60% |
| Med Mutual Of Oh Mcr | $70 | 60% |
| Molina Mcr | $70 | 60% |
| Summacare Mcr | $70 | 60% |
| The Health Plan Mcr Adv | $70 | 60% |
| Valor Hp Mcr-All Plans | $70 | 60% |
| Aultcare/Primecare Mcr Adv | $86 - $94 | 73% |
| Magnipower-All Plans | $92 | 78% |
| Caresource Exch - All Other Plans | $101 | 86% |
| Molina Marketplace - All Other Plans | $120 | 102% |
| Cerco-All Plans | $123 - $134 | 105% |
| Aultcare Wayne County | $132 - $144 | 112% |
| Aultcare/Primetime Exch | $132 - $144 | 112% |
| Rayco-All Plans | $132 - $144 | 112% |
| Clarity Health - All Plans | $137 | 117% |
| Christian Health Ministries-All Plans | $141 - $154 | 120% |
| Cigna | $141 - $154 | 120% |
| Health Ohio Network Employer | $141 - $154 | 120% |
| Wayne County-All Plans | $141 - $154 | 120% |
| Healthsmart Accel | $146 - $159 | 124% |
| Summacare Preferred Choice | $146 - $159 | 124% |
| Health Ohio Network Ppo-All Other Plans | $150 - $163 | 128% |
| Healthsmart Complete Ppo-All Other Plans | $150 - $163 | 128% |
| Ohio Health Choice Supp | $150 - $163 | 128% |
| Ohio Health Group Hlthy - All Other Plans | $150 - $163 | 128% |
| Med Mutual Of Oh Exchange | $152 - $165 | 129% |
| Med Mutual Of Oh Supermed | $152 - $165 | 129% |
| Med Mutual Of Oh Trad-All Other Plans | $152 - $165 | 129% |
| Health Plan Of Upper Ohio-All Plans | $155 - $169 | 132% |
| The Health Plan Comm - All Other Plans | $155 - $169 | 132% |
| Ohio Health Group Pref | $157 - $171 | 134% |
| Aultcare/Primetime-All Other Plans | $159 - $173 | 135% |
| Healthsmart Ppo | $161 - $175 | 137% |
| Summacare-All Other Plans | $164 - $179 | 139% |
| Ohio Health Choice-All Other Plans | $166 - $180 | 141% |
| Healthsmart Hpo | $168 - $182 | 143% |
| Osu-All Plans | $168 - $182 | 143% |
| Central Benefits-All Plans | $169 - $184 | 144% |
| First Health-All Plans | $169 - $184 | 144% |
| Flora-All Plans | $169 - $184 | 144% |
| Beech Street-All Plans | $171 - $186 | 145% |
| Phcs-All Plans | $171 - $186 | 145% |