CMS Price Transparency Data

Hospital observation (per hour)

Facility: Sarah D Culbertson Memorial Hospital

Billing Code: G0378 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0378
Insurance Median: $98
Cash Discount Price: $98
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Hospital observation (per hour) at Sarah D Culbertson Memorial Hospital is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 238 South Congress Street, Rushville, IL.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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 (%)

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Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$45 - $2,285	N/A
Humana	$47	N/A
Molina Mmai-All Other Plans	$47	N/A
UnitedHealthcare	$47 - $98	N/A
Aetna	$48 - $2,285	N/A
Cigna	$81	N/A
Beech Street-All Plans	$98	N/A
Encompass-All Plans	$98	N/A
Health Dynamics-All Plans	$98	N/A
Healthlink-All Plans	$98	N/A
Hfn EPO	$98	N/A
Hfn PPO Ip/Op Only-All Other Plans	$98	N/A
Multiplan/Phcs-All Plans	$98	N/A
Preferred Medical Claims Solution-All Plans	$98	N/A
Three Rivers Provider Network-All Plans	$98	N/A
Wexford Ip/Op Only-All Plans	$98	N/A
Healthsmart-All Plans	$104	N/A
Corvel-All Plans	$2,285	N/A
Meridian Hp McAid-All Plans	$2,285	N/A
Molina Healthcare McAid	$2,285	N/A

Consumer Guidance & Cost Commentary

For patients paying cash directly, the most important thing to know is that the cash rate for this hospital observation service is $98 per hour. Because this facility is a government-owned Critical Access Hospital, the cash price is identical to the median negotiated rate of $98 and the median paid rate of $98, meaning there is no difference between the cash price and what insurance plans typically pay. If you have a high-deductible plan where your insurance negotiated rate exceeds $98, paying cash upfront could result in lower out-of-pocket costs, provided you secure a "waiver of insurance submission" to prevent the hospital from sending a claim to your insurer.

While this specific cash rate of $98 is consistent with the facility's negotiated rates, it is important to note that some commercial payers, such as Blue Cross Blue Shield, Aetna, and Corvel, have negotiated rates as high as $2,285 per hour. This significant variance highlights why checking your specific plan's allowed amount before scheduling is crucial. Although the data does not provide a specific county or state average for this procedure, the uniformity of rates at this government-owned facility suggests that the cash price aligns with the facility's operational baseline rather than the broader market fluctuations seen with out-of-network commercial rates.

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 $98.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sarah D Culbertson Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0378.
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.