Office visit, established patient (20-29 min)
Facility: Pratt Regional Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $140
- Cash Discount Price: $108
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Christian Health Aid | $94 - $151 | 99% |
| UnitedHealthcare | $104 - $205 | 109% |
| Health Partners Of Kansas | $106 - $171 | 111% |
| Aetna | $113 - $181 | 119% |
| Choicecare | $125 - $201 | 131% |
Consumer Guidance & Cost Commentary
For this office visit at Pratt Regional Medical Center in Pratt, Kansas, the cash price of $108.00 is notably lower than the facility's negotiated rates with major payers, which range from $94 to $205 depending on the insurance plan. While the cash rate is higher than the Medicare benchmark of $95.19, it remains significantly below the commercial negotiated amounts, which can sometimes exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find this cash rate advantageous if their insurance negotiated rate for this service is higher than $108.00, as paying out-of-pocket could result in immediate savings compared to the insurer's allowed amount.
To ensure you are receiving the most accurate pricing, it is important to request an itemized bill before finalizing payment, as summary bills often obscure individual charges that could be disputed. Additionally, you should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% if settled in full upfront. While the facility's overall rating is 4 out of 5, the specific pricing for this CPT code reflects a standard established patient visit where the cash median of $108.00 serves as a clear baseline for comparison against the broader market rates found in the region.