CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Sarah D Culbertson Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $219
  • Cash Discount Price: $220
  • vs. Medicare Baseline: 1.62x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Sarah D Culbertson Memorial Hospital is $219. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $220. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.62x the Medicare baseline. Located in 238 South Congress Street, Rushville, IL.
Cash / Self-Pay
$220

Average discount available for prompt cash payment at this facility.

Insurance Median
$219

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $220 (162%)
Insurance Median: $219 (162%)
Cash: $220 (162% of Medicare)
Ins. Median: $219 (162% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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 $66 - $436 49%
Blue Cross Blue Shield $66 - $475 49%
Meridian Hp Mcaid-All Plans $66 49%
Molina Healthcare Mcaid $66 49%
Cigna $103 - $358 76%
Humana $104 - $254 77%
Molina Mmai-All Other Plans $104 - $254 77%
UnitedHealthcare $104 - $436 77%
Health Dynamics-All Plans $193 - $436 142%
Beech Street-All Plans $217 - $436 160%
Encompass-All Plans $217 - $436 160%
Healthlink-All Plans $217 - $436 160%
Hfn Epo $217 - $436 160%
Hfn Ppo Ip/Op Only-All Other Plans $217 - $436 160%
Multiplan/Phcs-All Plans $217 - $436 160%
Preferred Medical Claims Solution-All Plans $217 - $436 160%
Three Rivers Provider Network-All Plans $217 - $436 160%
Wexford Ip/Op Only-All Plans $217 - $436 160%
Healthsmart-All Plans $229 - $461 169%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 238 South Congress Street, Rushville, IL 62681
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals