CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Anderson Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $227
Cash Discount Price: $185
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Anderson Hospital is $227. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.67x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.

Cash / Self-Pay

$185

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: $185 (136%)

Insurance Median: $227 (167%)

Cash: $185 (136% 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
Medicaid / KanCare	$42 - $220	31%
Work Comp	$83 - $26,600	61%
Health Care Service Corporation	$119 - $190	88%
Tricare	$123 - $50,000	91%
Humana	$133	98%
Medicare (plans)	$133 - $135	98%
UnitedHealthcare	$133 - $302	98%
Blue Choice	$159 - $22,500	117%
Self Pay	$177 - $25,000	131%
Blue Cross Blue Shield	$189 - $231	139%
Healthlink	$190 - $291	140%
Mercy Benefit Admin	$206 - $270	152%
Aetna	$208 - $245	153%
Mercy Aco	$220 - $270	162%
Cigna	$230 - $270	170%
Multiplan/Phcs	$265 - $311	195%
Beech Street Corporation	$318 - $374	235%

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 $185.
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 Anderson 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.