Office visit, established patient (20-29 min)
Facility: Nmc Health
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $100
- Cash Discount Price: $103
- vs. Medicare Baseline: 1.05x 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 |
|---|---|---|
| Bluestem Pace | $53 | 56% |
| Wppa | $70 - $88 | 74% |
| Occunet | $77 - $96 | 81% |
| Samaritan Ministries International | $83 - $104 | 87% |
| Medincrease Health Plan | $83 - $104 | 87% |
| Medicaid / KanCare | $85 | 89% |
| Leading Age | $85 | 89% |
| Prime Health Services | $96 - $120 | 101% |
| Aetna | $105 - $132 | 110% |
| UnitedHealthcare | $115 - $144 | 121% |
| Cigna | $122 - $152 | 128% |
| Blue Cross Blue Shield | $133 | 140% |
Consumer Guidance & Cost Commentary
For this office visit at Nmc Health in Newton, KS, the cash price of $103 is significantly lower than the negotiated rates charged to most major insurance plans, which range from $70 to $152 depending on the carrier. While the facility's cash rate is competitive, it is important to note that commercial insurance contracts often include administrative overhead that inflates the baseline price by 20% to 40% above the actual cost of care. For patients with high-deductible plans, paying the cash price upfront can be a strategic choice, as it avoids the higher negotiated rates that insurers charge, provided the patient's out-of-pocket costs do not exceed the savings. Additionally, patients should verify if the facility offers a "prompt-pay" discount for settling the bill in full within 30 days, which could further reduce the final amount owed.
The data indicates that this service is priced at 110% of the Medicare benchmark rate of $95.19, suggesting a markup consistent with commercial pricing structures. Although the facility is a voluntary non-profit acute care hospital with a high consumer rating, the specific CPT code for this established patient visit does not show a direct comparison to state or county averages in the provided dataset. To ensure you are receiving the best possible rate, it is recommended to request an itemized bill before finalizing payment, as over 80% of hospital invoices contain errors such as double-billing or unbundled codes. If you receive a balance bill from an out-of-network provider, you may be entitled to protections under the No Surprises Act, which prevents providers from charging you the difference between their full rate and your insurance allowed amount for emergency or non