CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: St Francis Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $318
Cash Discount Price: $286
vs. Medicare Baseline: 3.34x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at St Francis Hospital is $318. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $286. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.34x the Medicare baseline. Located in 1215 Franciscan Dr, Litchfield, IL.

Cash / Self-Pay

$286

Average discount available for prompt cash payment at this facility.

Insurance Median

$318

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: $286 (300%)

Insurance Median: $318 (334%)

Cash: $286 (300% of Medicare)

Ins. Median: $318 (334% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 334% of the Medicare baseline (a markup of 234%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Clear Spring Health of Illinois	$83	87%
Blue Cross Blue Shield	$83 - $91	87%
Humana	$83	87%
Aetna	$87 - $279	91%
UnitedHealthcare	$87 - $397	91%
Molina Healthcare	$88	92%
Illinois Breast and Cervical Cancer Program	$94	99%
Amish Community	$111	117%
Celtic Insurance Company	$201	211%
Claim Doc	$208	219%
Hopetrust	$228	240%
Wellfirst	$255	268%
First Health	$295	310%
Caterpillar, Inc.	$318	334%
Current Health Solutions	$333	350%
Consociate Group	$337	354%
Multiplan/Phcs	$337	354%
Healthlink	$339	356%
Cigna	$353	371%
Provider Network of America	$357	375%
Healthcare Finest Network (Hfn)	$357	375%
Healthscope	$397	417%
Interplan	$397	417%
Health Alliance Medical Plans	$397	417%
Naphcare	$397	417%
Live360	$397	417%

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 $286.
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 St Francis 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.