CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Wooster Community Hospital
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $120
- Cash Discount Price: $151
- vs. Medicare Baseline: 1.26x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Wooster Community Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.26x the Medicare baseline. Located in 1761 Beall Avenue, Wooster, OH.
Cash / Self-Pay
$151
Average discount available for prompt cash payment at this facility.
Insurance Median
$120
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$95.19
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $95.19 (100%)
Cash / Self-Pay: $151 (159%)
Insurance Median: $120 (126%)
Cash: $151 (159% of Medicare)
Ins. Median: $120 (126% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $95.19 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 |
|---|---|---|
| Tricare | $55 | 58% |
| Blue Cross Blue Shield | $57 - $162 | 60% |
| Buckeye Mcare | $57 | 60% |
| Caresource Mcr Adv | $57 | 60% |
| Humana | $57 - $166 | 60% |
| Med Mutual Of Oh Mcr | $57 | 60% |
| Molina Mcr | $57 | 60% |
| Summacare Mcr | $57 | 60% |
| The Health Plan Mcr Adv | $57 | 60% |
| UnitedHealthcare | $57 - $168 | 60% |
| Valor Hp Mcr-All Plans | $57 | 60% |
| Buckeye Mcaid-All Other Plans | $60 | 63% |
| Caresource Mcaid | $60 | 63% |
| Aultcare/Primecare Mcr Adv | $61 - $86 | 64% |
| Molina Mcaid | $61 | 64% |
| Aetna | $63 - $176 | 66% |
| Amerihealth Mcaid-All Plans | $63 | 66% |
| Magnipower-All Plans | $73 | 77% |
| Caresource Exch - All Other Plans | $81 | 85% |
| Cerco-All Plans | $87 - $123 | 91% |
| Aultcare Wayne County | $93 - $132 | 98% |
| Aultcare/Primetime Exch | $93 - $132 | 98% |
| Rayco-All Plans | $93 - $132 | 98% |
| Molina Marketplace - All Other Plans | $96 | 101% |
| Christian Health Ministries-All Plans | $99 - $141 | 104% |
| Cigna | $99 - $141 | 104% |
| Health Ohio Network Employer | $99 - $141 | 104% |
| Wayne County-All Plans | $99 - $141 | 104% |
| Healthsmart Accel | $103 - $146 | 108% |
| Summacare Preferred Choice | $103 - $146 | 108% |
| Health Ohio Network Ppo-All Other Plans | $105 - $150 | 110% |
| Healthsmart Complete Ppo-All Other Plans | $105 - $195 | 110% |
| Ohio Health Choice Supp | $105 - $150 | 110% |
| Ohio Health Group Hlthy - All Other Plans | $105 - $150 | 110% |
| Med Mutual Of Oh Exchange | $107 - $152 | 112% |
| Med Mutual Of Oh Supermed | $107 - $152 | 112% |
| Med Mutual Of Oh Trad-All Other Plans | $107 - $152 | 112% |
| Health Plan Of Upper Ohio-All Plans | $109 - $155 | 115% |
| The Health Plan Comm - All Other Plans | $109 - $155 | 115% |
| Clarity Health - All Plans | $110 | 116% |
| Ohio Health Group Pref | $110 - $157 | 116% |
| Aultcare/Primetime-All Other Plans | $111 - $159 | 117% |
| Healthsmart Ppo | $113 - $161 | 119% |
| Summacare-All Other Plans | $115 - $164 | 121% |
| Ohio Health Choice-All Other Plans | $116 - $166 | 122% |
| Healthsmart Hpo | $118 - $168 | 124% |
| Osu-All Plans | $118 - $168 | 124% |
| Central Benefits-All Plans | $119 - $169 | 125% |
| First Health-All Plans | $119 - $169 | 125% |
| Flora-All Plans | $119 - $169 | 125% |
| Beech Street-All Plans | $120 - $171 | 126% |
| Phcs-All Plans | $120 - $171 | 126% |