Office visit, established patient (20-29 min)
Facility: Mcpherson Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $222
- Cash Discount Price: $191
- vs. Medicare Baseline: 2.33x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 233% of the Medicare baseline (a markup of 133%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Medicaid / KanCare | $46 - $441 | 48% |
| UnitedHealthcare | $46 - $441 | 48% |
| Health Blue Mcaid - All Other Plans | $47 - $450 | 49% |
| Tricare | $48 | 50% |
| Ambetter / Centene | $55 - $63 | 58% |
| Humana | $55 | 58% |
| Va Ccn - All Plans | $55 | 58% |
| Healthy Blue Mcr Adv | $55 | 58% |
| Blue Cross Blue Shield | $55 | 58% |
| Wellcare Mcr Adv - All Plans | $55 | 58% |
| Aetna | $66 - $441 | 69% |
| Multiplan - All Plans | $68 - $397 | 71% |
| Medical Associates - All Plans | $156 - $331 | 164% |
| Central Plains - All Plans | $156 - $331 | 164% |
| Wppa - All Plans | $164 - $309 | 172% |
| Christian Health Aid - All Plans | $187 - $353 | 196% |
| Cigna | $198 - $419 | 208% |
| Health Partners - All Plans | $198 - $419 | 208% |
| First Health - All Plans | $222 - $419 | 233% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit for an established patient lasting 20 to 29 minutes, McPherson Hospital in Kansas lists a cash median of $191.00 and a median negotiated rate of $222.00. This cash price is notably lower than the facility's gross charge of $258.00 and represents a significant discount compared to the Medicare benchmark of $95.19, with the cash rate being approximately 2.3 times the Medicare amount. While many commercial payers, such as Medicaid/KanCare and UnitedHealthcare, have negotiated rates ranging from $46 to $441, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $191.00. It is important to note that while the facility is a voluntary non-profit acute care hospital, patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary.
Patients should be aware that commercial negotiated rates often include administrative overhead and can exceed cash prices due to multi-layered contract dynamics. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to request a self-pay or prompt-pay discount before check-in to avoid automatic claims submission that could void cash savings. If a patient receives an itemized bill, they should request a full line-by-line audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected. By comparing the facility's rates directly to the Medicare benchmark and actively seeking prompt-pay incentives, consumers can