CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $67
Cash Discount Price: $59
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Memorial Hospital is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.49x the Medicare baseline. Located in 1454 N County Road 2050 E, Carthage, IL.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $59 (44%)

Insurance Median: $67 (49%)

Cash: $59 (44% of Medicare)

Ins. Median: $67 (49% 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
Aetna	$21 - $92	15%
Blue Cross Blue Shield	$21 - $92	15%
Cigna	$21 - $74	15%
Health Alliance	$21 - $92	15%
Humana	$21 - $92	15%
Meridian	$21 - $92	15%
Molina	$21 - $92	15%
UnitedHealthcare	$21 - $92	15%
Consociate	$63 - $74	46%
Healthlink	$63 - $74	46%
Private Healthcare Systems	$63	46%
Integrated Health Plan	$65	48%
First Health Network	$66 - $74	49%
Health Dynamics	$67	49%
Health First Network	$67	49%
Health Payors Org	$67	49%
Iowa Health Solutions	$67	49%
Multiplan	$67	49%
Pponext	$67	49%
Preferred Plan Inc	$67	49%
Three Rivers Provider Network	$67	49%
Corvel	$70	52%

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 $59.
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 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.