CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Nationwide Children's Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $199
Cash Discount Price: $244
vs. Medicare Baseline: 2.09x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Nationwide Children's Hospital is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $244. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.09x the Medicare baseline. Located in 700 Children's Drive, Columbus, OH.

Cash / Self-Pay

$244

Average discount available for prompt cash payment at this facility.

Insurance Median

$199

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: $244 (256%)

Insurance Median: $199 (209%)

Cash: $244 (256% of Medicare)

Ins. Median: $199 (209% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 209% of the Medicare baseline (a markup of 109%). 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
Amerihealth	$49 - $106	51%
Bchp	$49 - $106	51%
Blue Cross Blue Shield	$49 - $1,260	51%
Caresource	$49 - $611	51%
Humana	$49 - $1,273	51%
Molina	$49 - $106	51%
UnitedHealthcare	$49 - $1,273	51%
Tricare	$81	85%
Cigna	$105 - $1,260	110%
Mmo	$106 - $1,260	111%
Aetna	$108 - $1,273	113%
Ohg	$108 - $1,206	113%
Ohio Ppo Connect	$109 - $1,246	115%
Osu	$109 - $1,246	115%
Ohc	$112 - $1,246	118%
Ahpo	$113 - $1,260	119%
Front Path Health Coalition	$113 - $1,260	119%
Unicare	$114 - $1,273	120%
The Health Plan	$115 - $1,286	121%
Emerald Health	$118 - $1,313	124%
First Health	$118 - $1,313	124%
Phcs	$118 - $1,313	124%

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 $244.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Nationwide Children's Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
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.