CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $107
Cash Discount Price: $179
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Nationwide Children's Hospital Toledo, LLC is $107. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $179. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.91x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$179

Average discount available for prompt cash payment at this facility.

Insurance Median

$107

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: $179 (152%)

Insurance Median: $107 (91%)

Cash: $179 (152% of Medicare)

Ins. Median: $107 (91% 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
Caresource	$43 - $70	37%
Amerihealth	$44 - $78	37%
Bchp	$44 - $78	37%
UnitedHealthcare	$44 - $151	37%
Paramount	$70	60%
Mcclaren Health Plan - Michigan	$72	61%
Blue Cross Blue Shield	$74 - $152	63%
Mmo	$75 - $105	64%
Humana	$78	66%
Molina	$78 - $117	66%
Mcclaren Health Plan	$92 - $135	78%
Tricare	$99	84%
Aetna	$115 - $150	98%
Front Path Health Coalition	$124 - $135	105%
Ohc	$150 - $209	128%
Ohio Ppo Connect	$150 - $209	128%
Cigna	$151 - $214	128%
First Health	$230	196%

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 $179.
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 Nationwide Children's Hospital Toledo, LLC 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.