CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Carle Eureka Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $129
Cash Discount Price: $255
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Carle Eureka Hospital is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $255. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.36x the Medicare baseline. Located in 101 S Major St, Eureka, IL.

Cash / Self-Pay

$255

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

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: $255 (268%)

Insurance Median: $129 (136%)

Cash: $255 (268% of Medicare)

Ins. Median: $129 (136% 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
Meridian	$21 - $144	22%
Molina	$42 - $144	44%
Humana	$46 - $135	48%
Aetna	$48 - $198	50%
UnitedHealthcare	$68 - $184	71%
Cigna	$82	86%
Wellcare	$93	98%
Community Partners Health Plan (Cphp)	$126 - $179	132%
Healthlink	$136 - $194	143%
Blue Cross Blue Shield	$141 - $251	148%
Multiplan/Phcs	$158 - $224	166%

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 $255.
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 Carle Eureka 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.