CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Hammond Henry Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $82
Cash Discount Price: $103
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Hammond Henry Hospital is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.86x the Medicare baseline. Located in 600 N College Avenue, Geneseo, IL.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $103 (108%)

Insurance Median: $82 (86%)

Cash: $103 (108% of Medicare)

Ins. Median: $82 (86% 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
Tricare	$16 - $217	17%
Aetna	$18 - $241	19%
Health Alliance Mcare Adv	$18 - $241	19%
Humana	$18 - $244	19%
UnitedHealthcare	$18 - $241	19%
Ambetter / Centene	$27 - $122	28%
Wellmark Of Ia-All Plans	$31 - $93	33%
Blue Cross Blue Shield	$34 - $175	36%
Springfield Armory-All Plans	$40 - $114	42%
Health Alliance-All Other Plans	$46 - $131	48%
Multiplan Integrated Hp	$46 - $131	48%
Cigna	$48 - $135	50%
Multiplan Pponext	$50 - $140	53%
Osf Direct Access Network-All Plans	$50 - $140	53%
Quad City Community Hc-All Plans	$50 - $140	53%
Multiplan-All Other Plans	$53 - $149	56%
Corvel-All Plans	$56 - $158	59%
Healthsmart Adult-All Other Plans	$56 - $158	59%
Healthsmart Pediatric	$56 - $158	59%
Hfn-All Plans	$56 - $158	59%
Multiplan Beech Street	$56 - $158	59%
Multiplan Phcs Adult	$56 - $158	59%
Multiplan Phcs Pediatric	$56 - $158	59%
Usa Mco-All Plans	$56 - $158	59%
Meridian Health Plan-All Plans	$114 - $175	120%

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 $103.
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 Hammond Henry 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.