CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Sarah D Culbertson Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $159
Cash Discount Price: $190
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Sarah D Culbertson Memorial Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $190. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.67x the Medicare baseline. Located in 238 South Congress Street, Rushville, IL.

Cash / Self-Pay

$190

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $190 (200%)

Insurance Median: $159 (167%)

Cash: $190 (200% of Medicare)

Ins. Median: $159 (167% 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
Aetna	$45 - $361	47%
Blue Cross Blue Shield	$45 - $393	47%
Meridian Hp Mcaid-All Plans	$45 - $87	47%
Molina Healthcare Mcaid	$45	47%
Cigna	$70 - $296	74%
Humana	$76 - $254	80%
Molina Mmai-All Other Plans	$76 - $254	80%
UnitedHealthcare	$76 - $361	80%
Health Dynamics-All Plans	$142 - $361	149%
Beech Street-All Plans	$149 - $361	157%
Encompass-All Plans	$149 - $361	157%
Healthlink-All Plans	$149 - $361	157%
Hfn Epo	$149 - $361	157%
Hfn Ppo Ip/Op Only-All Other Plans	$149 - $361	157%
Multiplan/Phcs-All Plans	$149 - $361	157%
Preferred Medical Claims Solution-All Plans	$149 - $361	157%
Three Rivers Provider Network-All Plans	$149 - $361	157%
Wexford Ip/Op Only-All Plans	$149 - $361	157%
Healthsmart-All Plans	$158 - $381	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 $190.
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 Sarah D Culbertson Memorial 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.