Office visit, established patient (20-29 min)
Facility: Saint John Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $107
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.12x 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 |
|---|---|---|
| Blue Cross Blue Shield | $63 - $133 | 66% |
| Early Detection Works | $87 | 91% |
Consumer Guidance & Cost Commentary
For this office visit at Saint John Hospital in Leavenworth, KS, the negotiated rates for CPT code 99213 range from $63 to $133 across Blue Cross Blue Shield plans and $87 for Early Detection Works. These commercial rates are significantly higher than the Medicare benchmark of $95.19, reflecting the administrative costs and contract structures inherent in insurance billing. While the facility's cash price is not listed, patients with high-deductible plans should consider that paying cash upfront could be more cost-effective if the negotiated rate exceeds the cash price. It is always advisable to ask the hospital directly about self-pay or prompt-pay discounts before scheduling, as these upfront fees can reduce the total amount owed.
When reviewing your final invoice, ensure you request a detailed itemized bill rather than accepting a summary statement, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Comparing this facility's pricing to state or county averages provides context, though specific average figures were not provided for this location. If you receive a balance bill from an out-of-network provider, remember that the No Surprises Act protects you from paying the difference for emergency care and non-emergency services at in-network facilities. Always verify your deductible status before using insurance, as paying the full negotiated rate without meeting your deductible can result in unexpected out-of-pocket costs.