CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Decatur Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $227
Cash Discount Price: $398
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Decatur Memorial Hospital is $227. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $398. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.67x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$398

Average discount available for prompt cash payment at this facility.

Insurance Median

$227

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $398 (294%)

Insurance Median: $227 (167%)

Cash: $398 (294% of Medicare)

Ins. Median: $227 (167% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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	$82 - $458	60%
Illinois Workers Compensation	$121 - $244	89%
Aetna	$130 - $307	96%
Coventry	$130 - $275	96%
Health Alliance	$130 - $305	96%
Humana	$130 - $357	96%
Medicare (plans)	$130	96%
UnitedHealthcare	$130 - $458	96%
Veterans Administration	$130	96%
Tricare	$132	97%
Mennonite Churches	$145 - $197	107%
Plain Church Medical Group	$152 - $206	112%
Health Alliance Mh Employee Plan	$155 - $211	114%
Cigna	$158 - $213	117%
Hfn	$169 - $344	125%
Commercial Workers Compensation	$171 - $231	126%
6 Degrees Health	$203 - $275	150%
Hopetrust	$203 - $275	150%
Hst	$203 - $275	150%
Medicaid / KanCare	$220 - $224	162%
Phcs Savility	$220 - $298	162%
Phcs Multiplan Ppo	$230 - $311	170%
Healthlink	$232 - $314	171%
Corvel	$243 - $330	179%
Consociate	$250 - $339	184%
Liability	$338 - $458	249%

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 $398.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.