CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Community Hospital of Staunton

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $62
Cash Discount Price: $60
vs. Medicare Baseline: 0.65x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Community Hospital of Staunton is $62. 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 0.65x the Medicare baseline. Located in 400 N Caldwell St, Staunton, IL.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $62 (65%)

Cash: $60 (63% of Medicare)

Ins. Median: $62 (65% 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
Self Pay	$15 - $106	16%
Cigna	$19 - $136	20%
Blue Cross Blue Shield	$22 - $211	23%
Healthlink	$22 - $180	23%
Tricare	$22 - $86	23%
Aetna	$24 - $211	25%
Health Alliance Commercial	$24 - $211	25%
Multiplan/Phcs	$25 - $180	26%
Beech Street	$27 - $192	28%
Clear Spring Health Ma	$29 - $96	30%
Medicare (plans)	$29 - $93	30%
Medicaid / KanCare	$30 - $362	32%
UnitedHealthcare	$30 - $211	32%

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 Community Hospital of Staunton 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.