CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Decatur Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $165
Cash Discount Price: $294
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Decatur Memorial Hospital is $165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $294. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.40x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$294

Average discount available for prompt cash payment at this facility.

Insurance Median

$165

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: $294 (250%)

Insurance Median: $165 (140%)

Cash: $294 (250% of Medicare)

Ins. Median: $165 (140% 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
Blue Cross Blue Shield	$56 - $359	48%
Mennonite Churches	$98 - $154	83%
Plain Church Medical Group	$103 - $162	88%
Health Alliance Mh Employee Plan	$105 - $165	89%
Cigna	$107 - $167	91%
Aetna	$114 - $241	97%
Coventry	$114 - $215	97%
Health Alliance	$114 - $239	97%
Humana	$114 - $233	97%
Medicare (plans)	$114	97%
UnitedHealthcare	$114 - $359	97%
Veterans Administration	$114	97%
Hfn	$115 - $269	98%
Tricare	$115	98%
Commercial Workers Compensation	$116 - $181	99%
Illinois Workers Compensation	$122 - $191	104%
6 Degrees Health	$137 - $215	117%
Hopetrust	$137 - $215	117%
Hst	$137 - $215	117%
Phcs Savility	$149 - $233	127%
Phcs Multiplan Ppo	$156 - $244	133%
Healthlink	$157 - $246	134%
Corvel	$165 - $258	140%
Consociate	$169 - $266	144%
Medicaid / KanCare	$220 - $224	187%
Liability	$229 - $359	195%

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 $294.
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 Decatur Memorial 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.