Office visit, established patient (20-29 min)
Facility: Salina Regional Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $190
- Cash Discount Price: $182
- vs. Medicare Baseline: 2.00x 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 |
|---|---|---|
| Preferred Phsic | $58 - $328 | 61% |
| Blue Cross Blue Shield | $71 - $75 | 75% |
| Preferred Healthcare - All Other Plans | $78 - $443 | 82% |
| Providers Care (Wppa)-All Plans | $87 - $493 | 91% |
| Aetna | $87 - $493 | 91% |
| Cigna | $87 - $493 | 91% |
| Multiplan (Mpi)-All Plans | $87 - $493 | 91% |
Consumer Guidance & Cost Commentary
For this office visit at Salina Regional Health Center in Salina, KS, the cash price of $182 is lower than the facility's negotiated rates with major insurers like Preferred Phsic ($58–$328) and Blue Cross Blue Shield ($71–$75). While the cash rate is also below the gross chargemaster of $260, it is important to note that commercial insurance contracts often result in higher final costs for patients due to administrative fees and the inclusion of deductible amounts. In this specific case, the cash price is significantly lower than the facility's median negotiated rate of $190 and the state average of $185, making self-pay a potentially more economical option for those who have met their insurance deductibles or hold high-deductible plans.
Patients should be aware that the facility's negotiated rates can sometimes exceed the cash price, particularly when insurance deductibles are not yet met. To minimize costs, individuals should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the higher administrative costs associated with insurance billing. Additionally, if a balance bill arises from out-of-network services, patients should verify the legality of the charge under the No Surprises Act and request an itemized audit to identify any unbundled codes or services not rendered, ensuring they are not paying for unnecessary charges.