CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Wooster Community Hospital
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $174
- Cash Discount Price: $201
- vs. Medicare Baseline: 1.28x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Wooster Community Hospital is $174. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $201. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.28x the Medicare baseline. Located in 1761 Beall Avenue, Wooster, OH.
Cash / Self-Pay
$201
Average discount available for prompt cash payment at this facility.
Insurance Median
$174
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$135.6
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $201 (148%)
Insurance Median: $174 (128%)
Cash: $201 (148% of Medicare)
Ins. Median: $174 (128% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $135.6 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
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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 | 44% |
| Caresource Mcaid | $60 | 44% |
| UnitedHealthcare | $60 - $229 | 44% |
| Molina Mcaid | $61 | 45% |
| Blue Cross Blue Shield | $62 - $222 | 46% |
| Aetna | $63 - $241 | 46% |
| Amerihealth Mcaid-All Plans | $63 | 46% |
| Tricare | $82 | 60% |
| Buckeye Mcare | $83 | 61% |
| Caresource Mcr Adv | $83 | 61% |
| Humana | $83 - $227 | 61% |
| Med Mutual Of Oh Mcr | $83 | 61% |
| Molina Mcr | $83 | 61% |
| Summacare Mcr | $83 | 61% |
| The Health Plan Mcr Adv | $83 | 61% |
| Valor Hp Mcr-All Plans | $83 | 61% |
| Aultcare/Primecare Mcr Adv | $90 - $118 | 66% |
| Magnipower-All Plans | $108 | 80% |
| Caresource Exch - All Other Plans | $119 | 88% |
| Cerco-All Plans | $128 - $169 | 94% |
| Aultcare Wayne County | $137 - $181 | 101% |
| Aultcare/Primetime Exch | $137 - $181 | 101% |
| Rayco-All Plans | $137 - $181 | 101% |
| Molina Marketplace - All Other Plans | $141 | 104% |
| Christian Health Ministries-All Plans | $146 - $193 | 108% |
| Cigna | $146 - $193 | 108% |
| Health Ohio Network Employer | $146 - $193 | 108% |
| Wayne County-All Plans | $146 - $193 | 108% |
| Healthsmart Accel | $152 - $200 | 112% |
| Summacare Preferred Choice | $152 - $200 | 112% |
| Health Ohio Network Ppo-All Other Plans | $156 - $205 | 115% |
| Healthsmart Complete Ppo-All Other Plans | $156 - $205 | 115% |
| Ohio Health Choice Supp | $156 - $205 | 115% |
| Ohio Health Group Hlthy - All Other Plans | $156 - $205 | 115% |
| Med Mutual Of Oh Exchange | $157 - $207 | 116% |
| Med Mutual Of Oh Supermed | $157 - $207 | 116% |
| Med Mutual Of Oh Trad-All Other Plans | $157 - $207 | 116% |
| Health Plan Of Upper Ohio-All Plans | $161 - $212 | 119% |
| The Health Plan Comm - All Other Plans | $161 - $212 | 119% |
| Clarity Health - All Plans | $162 | 119% |
| Ohio Health Group Pref | $163 - $215 | 120% |
| Aultcare/Primetime-All Other Plans | $165 - $217 | 122% |
| Healthsmart Ppo | $167 - $219 | 123% |
| Summacare-All Other Plans | $170 - $224 | 125% |
| Ohio Health Choice-All Other Plans | $172 - $227 | 127% |
| Healthsmart Hpo | $174 - $229 | 128% |
| Osu-All Plans | $174 - $229 | 128% |
| Central Benefits-All Plans | $176 - $231 | 130% |
| First Health-All Plans | $176 - $231 | 130% |
| Flora-All Plans | $176 - $231 | 130% |
| Beech Street-All Plans | $178 - $234 | 131% |
| Phcs-All Plans | $178 - $234 | 131% |