CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Hamilton Memorial Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $235
  • Cash Discount Price: $299
  • vs. Medicare Baseline: 2.00x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Hamilton Memorial Hospital is $235. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $299. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 2.00x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.
Cash / Self-Pay
$299

Average discount available for prompt cash payment at this facility.

Insurance Median
$235

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $299 (254%)
Insurance Median: $235 (200%)
Cash: $299 (254% of Medicare)
Ins. Median: $235 (200% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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.

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 $54 - $299 46%
Blue Cross Blue Shield $54 - $302 46%
Medicaid / KanCare $54 - $133 46%
Meridian Health $54 46%
Health Alliance $115 - $265 98%
Medicare (plans) $115 - $133 98%
UnitedHealthcare $115 - $238 98%
Wellcare $115 - $133 98%
Alliance Coal $121 - $232 103%
Humana $133 113%
Hope Trust $231 - $249 196%
Multiplan $231 - $282 196%
Healthscope $232 197%
Wellfirst (Ssmhic) $232 197%
Cigna $260 221%
Hfn, Inc $265 - $410 225%
Healthlink $282 - $299 240%
Siho $299 254%
Three Rivers Provider $299 - $410 254%
Healthsmart $315 268%
Stratose $315 - $433 268%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 611 S Marshall Avenue, McLeansboro, IL 62859
  • CMS Rating: ★★★☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals