CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Fostoria Community Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $100
Cash Discount Price: $100
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Fostoria Community Hospital is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.74x the Medicare baseline. Located in 501 Van Buren Street, Fostoria, OH.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $100 (74%)

Insurance Median: $100 (74%)

Cash: $100 (74% of Medicare)

Ins. Median: $100 (74% 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

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
Paramount Health Care	$32 - $125	24%
Health Value Management	$33 - $128	24%
Aetna	$34 - $147	25%
Blue Cross Blue Shield	$34 - $154	25%
Buckeye Community Health Plan	$34 - $135	25%
Health Alliance Plan	$34 - $154	25%
Veterans Affairs	$34	25%
Dayton Area Health Plan Dba Caresource	$55 - $154	41%
UnitedHealthcare	$55 - $133	41%
Buckeye Community Health Plan Inc	$56 - $145	41%
Medical Mutual Of Ohio	$87 - $93	64%
Frontpath Health Coalition	$89	66%
Ohio Health Choice	$100	74%
Ohio Ppo Connect	$100 - $116	74%
Health Ohio Network	$122	90%
Connecticut General Life Insurance Company	$123	91%
Amerihealth	$140	103%

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 $100.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fostoria Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
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.