CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Deaconess Illinois Crossroads

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $86
Cash Discount Price: $60
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Deaconess Illinois Crossroads is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.90x the Medicare baseline. Located in 8 Doctors Park Rd, Mount Vernon, IL.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $60 (63%)

Insurance Median: $86 (90%)

Cash: $60 (63% of Medicare)

Ins. Median: $86 (90% 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
Aetna	$45 - $134	47%
Blue Cross Blue Shield	$45 - $86	47%
Meridian Health Plan	$45 - $86	47%
Molina Healthcare Of Illinois	$45 - $87	47%
Wellcare	$45 - $86	47%
Healthlink	$50 - $54	53%
Self-Pay	$60	63%
Humana	$63 - $133	66%
Mytru Advantage	$63 - $86	66%
Umwa	$63 - $86	66%
UnitedHealthcare	$63 - $86	66%
Cigna	$66	69%
Deaconess Onecare	$68	71%
Alliance Coal	$87 - $142	91%
Care Improvement Plus	$88	92%
Alter-Net Medical Services, Inc.	$101 - $246	106%
Noncontracted	$101 - $138	106%
Prime Health Services	$128	134%
Guardian Resources, Inc.	$143	150%
Healthcare'S Finest Network (Hfn)	$144	151%
Medicalcontrol Network Solutions	$144	151%
National Provider Network	$144	151%
Three Rivers Provider Network	$148	155%
Beech Street	$150	158%
Hope Trust	$246	258%

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 $60.
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 Deaconess Illinois Crossroads 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.