CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: St Francis Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $521
Cash Discount Price: $446
vs. Medicare Baseline: 3.84x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at St Francis Hospital is $521. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $446. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.84x the Medicare baseline. Located in 1215 Franciscan Dr, Litchfield, IL.

Cash / Self-Pay

$446

Average discount available for prompt cash payment at this facility.

Insurance Median

$521

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: $446 (329%)

Insurance Median: $521 (384%)

Cash: $446 (329% of Medicare)

Ins. Median: $521 (384% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 384% of the Medicare baseline (a markup of 284%). 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
Blue Cross Blue Shield	$130 - $143	96%
Humana	$130	96%
Clear Spring Health of Illinois	$130	96%
Aetna	$136 - $436	100%
UnitedHealthcare	$136 - $620	100%
Molina Healthcare	$137	101%
Amish Community	$174	128%
Celtic Insurance Company	$314	232%
Claim Doc	$326	240%
Hopetrust	$356	263%
Wellfirst	$399	294%
First Health	$460	339%
Caterpillar, Inc.	$497	367%
Current Health Solutions	$521	384%
Multiplan/Phcs	$527	389%
Consociate Group	$527	389%
Healthlink	$529	390%
Cigna	$552	407%
Healthcare Finest Network (Hfn)	$558	412%
Provider Network of America	$558	412%
Healthscope	$620	457%
Naphcare	$620	457%
Health Alliance Medical Plans	$620	457%
Interplan	$620	457%
Live360	$620	457%
Illinois Breast and Cervical Cancer Program	$620	457%

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 $446.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.