CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Avita Ontario

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $507
Cash Discount Price: $108
vs. Medicare Baseline: 4.31x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Avita Ontario is $507. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 4.31x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$507

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: $108 (92%)

Insurance Median: $507 (431%)

Cash: $108 (92% of Medicare)

Ins. Median: $507 (431% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 431% of the Medicare baseline (a markup of 331%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Molina	$65 - $5,629	55%
Blue Cross Blue Shield	$77 - $3,518	65%
Cigna	$99	84%
Medical_Mutual	$102 - $3,588	87%
Aetna	$108 - $3,588	92%
United_Healthcare	$108 - $888	92%
Caresource	$116	99%
Medicaid / KanCare	$116	99%
Ohiorise	$116	99%
Amerihealth	$122	104%
Buckeye	$125 - $3,518	106%
Humana	$125 - $3,518	106%
Medicare (plans)	$888 - $3,518	755%
Mount_Carmel	$888 - $3,518	755%

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 $108.
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 Avita Ontario 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.