CMS Price Transparency Data

Review of medical records for care

Facility: Fhn Memorial Hospital

Billing Code: 90889 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90889
Insurance Median: $154
Cash Discount Price: $156
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Review of medical records for care at Fhn Memorial Hospital is $154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1045 West Stephenson Street, Freeport, IL.

Cash / Self-Pay

$156

Average discount available for prompt cash payment at this facility.

Insurance Median

$154

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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
Meridian Health Plan - All Plans	$86	N/A
Aetna	$109	N/A
The Alliance - All Plans	$117	N/A
Ecoh Nihp	$123	N/A
Nihp Employ - All Plans	$123	N/A
Quartz - All Other Plans	$127	N/A
Blue Cross Blue Shield	$132	N/A
Ecoh - All Other Plans	$133	N/A
Northern Il Hp - All Plans	$135	N/A
First Health - All Plans	$137	N/A
UnitedHealthcare	$152	N/A
Humana	$154	N/A
Hfn - All Plans	$160	N/A
First Choice Il - All Plans	$166	N/A
Multiplan Phcs - All Plans	$166	N/A
Wps - All Plans	$170	N/A
Galaxy - All Plans	$176	N/A
Health Alliance - All Other Plans	$176	N/A
Interplan Health - All Plans	$176	N/A
Preferred Plan Ppo - All Plans	$176	N/A
Trustmark - All Plans	$179	N/A
Midland Choice - All Plans	$185	N/A
Osf Healthplans - All Plans	$195	N/A

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 $156.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90889.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fhn Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90889.
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.