CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Warner Hospital and Health Services

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99213
  • Insurance Median: $152
  • Cash Discount Price: $266
  • vs. Medicare Baseline: 1.60x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Warner Hospital and Health Services is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $266. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.60x the Medicare baseline. Located in 422 W White St, Clinton, IL.
Cash / Self-Pay
$266

Average discount available for prompt cash payment at this facility.

Insurance Median
$152

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: $266 (279%)
Insurance Median: $152 (160%)
Cash: $266 (279% of Medicare)
Ins. Median: $152 (160% 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.

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 $71 - $345 75%
Aetna $73 - $299 77%
Health Alliance Med Adv $73 - $144 77%
Humana $73 - $299 77%
Molina Mcr/Mcd Dual $73 - $144 77%
UnitedHealthcare $73 - $299 77%
Wellcare Mcr Adv-All Plans $73 - $144 77%
Healthlink Hmo $140 - $275 147%
City Of Clinton (Employees Serv)-All Plans $143 - $282 150%
Cigna $149 - $292 157%
Caterpillar-All Plans $152 - $299 160%
Multiplan Phcs-All Plans $152 - $299 160%
Health Alliance-All Other Plans $158 - $310 166%
Healthlink Ppo/Work Comp-All Other Plans $158 - $310 166%
Consociate Care Ppo-All Plans $161 - $317 169%
Hfn Ppo/Epo-All Plans $161 - $317 169%
Three Rivers-All Plans $170 - $334 179%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 422 W White St, Clinton, IL 61727
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals