Office visit, established patient (20-29 min)
Facility: Stormont Vail Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $116
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.22x 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 | $99 - $133 | 104% |
Consumer Guidance & Cost Commentary
This CPT code represents an office visit for an established patient lasting between 20 and 29 minutes at Stormont Vail Hospital in Topeka, Kansas. While the facility's negotiated rate for this service is $116.00, the median amount paid by Blue Cross Blue Shield plans in this region is significantly higher at $33,276.00, reflecting the administrative costs and contract structures inherent to commercial insurance billing. It is important to note that cash-pay rates for this specific procedure are not available in the current data; however, patients with high-deductible plans should be aware that paying out-of-pocket can sometimes be more cost-effective if the insurance negotiated rate exceeds the cash price, though this facility does not currently list a cash median.
To ensure you are not overcharged, it is crucial to request a full itemized billing audit before finalizing any payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that should be consolidated. Additionally, if you are receiving care from an out-of-network provider at this in-network facility, the No Surprises Act protects you from balance billing for emergency and non-emergency services, meaning you should dispute any surprise bills immediately rather than paying them out of fear of credit damage. Finally, before scheduling your visit, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can offer a fee reduction of 20% to 50% if you agree to pay in full upfront, bypassing the costly insurance claims processing cycle.