Office visit, established patient (20-29 min)
Facility: Madison County Health Care System
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $162
- Cash Discount Price: $183
- vs. Medicare Baseline: 1.70x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $53 - $300 | 56% |
| Choicecare-All Plans | $55 - $316 | 58% |
| Medical Associates Hp - All Plans | $55 - $287 | 58% |
| Medimore Employee Hp - All Plans | $55 - $326 | 58% |
| Tricare | $55 - $287 | 58% |
| Iowa Total Care Mcaid-All Plans | $74 - $223 | 78% |
| Molina Mcaid/Chip -All Plans | $77 - $229 | 81% |
| Amerigroup Mcaid-All Plans | $79 - $236 | 83% |
| Madison County Sheriff-All Plans | $79 - $166 | 83% |
| Blue Cross Blue Shield | $81 - $180 | 85% |
| Oscar - All Plans | $93 - $431 | 98% |
| Midlands Choice - All Plans | $97 - $326 | 102% |
| Aetna | $101 - $287 | 106% |
| Medigold-All Plans | $101 - $287 | 106% |
| American Hp Mcr Adv-All Plans | $106 - $302 | 111% |
| Corvel Wc-All Plans | $142 - $300 | 149% |
| First Choice-All Plans | $150 - $316 | 158% |
| First Health-All Plans | $150 - $316 | 158% |
| Integrated Hp-All Plans | $150 - $316 | 158% |
| Mutual Of Omaha-All Plans | $150 - $316 | 158% |
| Plaines Health-All Plans | $150 - $316 | 158% |
| Preferred Hlth Ntwork-All Plans | $150 - $316 | 158% |
| Principal Healthcare-All Plans | $150 - $316 | 158% |
| Usa Managed Care-All Plans | $150 - $316 | 158% |
| Benefit Admin Of America-All Plans | $158 - $333 | 166% |