CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Decatur Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $156
Cash Discount Price: $270
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Decatur Memorial Hospital is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $270. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.64x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$270

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $270 (284%)

Insurance Median: $156 (164%)

Cash: $270 (284% of Medicare)

Ins. Median: $156 (164% 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.

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 - $311	59%
Illinois Workers Compensation	$82 - $165	86%
Aetna	$91 - $209	96%
Coventry	$91 - $187	96%
Health Alliance	$91 - $207	96%
Humana	$91 - $202	96%
Medicare (plans)	$91	96%
UnitedHealthcare	$91 - $311	96%
Veterans Administration	$91	96%
Tricare	$93	98%
Mennonite Churches	$98 - $134	103%
Plain Church Medical Group	$103 - $140	108%
Health Alliance Mh Employee Plan	$105 - $143	110%
Cigna	$107 - $145	112%
Hfn	$115 - $233	121%
Commercial Workers Compensation	$116 - $157	122%
6 Degrees Health	$137 - $187	144%
Hopetrust	$137 - $187	144%
Hst	$137 - $187	144%
Phcs Savility	$149 - $202	157%
Phcs Multiplan Ppo	$156 - $211	164%
Healthlink	$157 - $213	165%
Corvel	$165 - $224	173%
Consociate	$169 - $230	178%
Medicaid / KanCare	$220 - $224	231%
Liability	$229 - $311	241%

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 $270.
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 Decatur Memorial 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.