CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Pinckneyville Community Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $166
Cash Discount Price: $229
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Pinckneyville Community Hospital is $166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.74x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$166

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: $229 (241%)

Insurance Median: $166 (174%)

Cash: $229 (241% of Medicare)

Ins. Median: $166 (174% 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	$50 - $528	53%
Healthlink Hmo	$50 - $461	53%
UnitedHealthcare	$53 - $481	56%
Healthlink Ppo - All Other Plans	$54 - $484	57%
Humana	$65 - $294	68%
Blue Cross Blue Shield	$68 - $423	71%
Cigna	$70 - $484	74%
Umwa Mcr Adv - All Plans	$74 - $294	78%
Wellcare Mcr Adv - All Plans	$74 - $294	78%
Ambetter / Centene	$87	91%
Medicaid / KanCare	$87	91%
Phcs - All Other Plans	$150 - $481	158%
Healthlink Work Comp	$151 - $484	159%
Phcs Savility	$156 - $499	164%
Multiplan - All Plans	$165 - $528	173%

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 $229.
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 Pinckneyville Community Hospital 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.