CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Pinckneyville Community Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $294
Cash Discount Price: $349
vs. Medicare Baseline: 2.17x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Pinckneyville Community Hospital is $294. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $349. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.17x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$349

Average discount available for prompt cash payment at this facility.

Insurance Median

$294

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: $349 (257%)

Insurance Median: $294 (217%)

Cash: $349 (257% of Medicare)

Ins. Median: $294 (217% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 217% of the Medicare baseline (a markup of 117%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$76 - $809	56%
Healthlink Hmo	$77 - $706	57%
UnitedHealthcare	$80 - $737	59%
Healthlink Ppo - All Other Plans	$83 - $742	61%
Humana	$96 - $333	71%
Blue Cross Blue Shield	$101 - $647	74%
Cigna	$103 - $742	76%
Phcs - All Other Plans	$218 - $737	161%
Healthlink Work Comp	$219 - $742	162%
Phcs Savility	$226 - $764	167%
Multiplan - All Plans	$239 - $809	176%
Umwa Mcr Adv - All Plans	$294 - $333	217%
Wellcare Mcr Adv - All Plans	$294 - $333	217%

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 $349.
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 Pinckneyville Community 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.