CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Mc Donough District Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $106
Cash Discount Price: $172
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Mc Donough District Hospital is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.90x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $172 (146%)

Insurance Median: $106 (90%)

Cash: $172 (146% of Medicare)

Ins. Median: $106 (90% 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
Health Alliance	$48 - $255	41%
Aetna	$69 - $286	59%
Hfn	$74 - $257	63%
UnitedHealthcare	$74 - $257	63%
Humana	$79 - $257	67%
Medicaid / KanCare	$79 - $286	67%
Medicare (plans)	$79 - $106	67%
Meridian	$79 - $106	67%
Molina	$79 - $286	67%
Mutual Medical	$79 - $286	67%
Veteran Affairs	$79 - $106	67%
Springfield Health	$235	200%
Consociate	$243	207%
Trilogy	$243	207%
Blue Choice	$257	219%
Current Health	$257	219%
Healthlink	$257 - $269	219%
Preferred Plan	$272	231%
Blue Cross Blue Shield	$286	243%

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 $172.
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 Mc Donough District Hospital 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.