CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Adena Pike Medical Center

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $136
Cash Discount Price: $90
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Adena Pike Medical Center is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.16x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $90 (77%)

Insurance Median: $136 (116%)

Cash: $90 (77% of Medicare)

Ins. Median: $136 (116% 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.

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
Aetna	$43 - $147	37%
Blue Cross Blue Shield	$43 - $156	37%
Buckeye Community Health Plan	$43	37%
Humana	$43 - $172	37%
Medical Mutual Of Ohio	$43 - $115	37%
Medigold	$43	37%
Molina	$43	37%
Care Source	$44	37%
Medical Mutual Of Ohio Supermed	$46 - $136	39%
Gateway Health	$60	51%
Molina Marketplace	$71	60%
Care Source Just4Me	$78	66%
Sidecar Health	$119	101%
Ohio Ppo Connect	$126	107%
The Health Plan	$126	107%
Cigna	$131	111%
First Health	$142	121%
Ohio Health Choice	$144	122%
UnitedHealthcare	$155	132%
Integrated Health Plan	$170	145%
Healthsmart	$172	146%
Multiplan/Private Healthcare Systems	$172	146%
Three Rivers Network	$172	146%

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 $90.
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 Adena Pike Medical Center 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.