Office visit, established patient (20-29 min)
Facility: Wesley Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $280
- Cash Discount Price: $934
- vs. Medicare Baseline: 2.94x 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 294% of the Medicare baseline (a markup of 194%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $54 | 57% |
| United | $141 - $420 | 148% |
| Health Partners Of Kansas | $162 - $467 | 170% |
| Aetna | $163 - $333 | 171% |
| Medical Associates Health Plan | $177 | 186% |
| Preferred Health Choices | $177 | 186% |
| Spirit Aerosystems | $299 | 314% |
| First Health | $431 | 453% |
| Triwest Healthcare Alliance | $607 | 638% |
| Multiplan | $654 - $841 | 687% |
| Usa Managed Care | $794 | 834% |
Consumer Guidance & Cost Commentary
For this office visit at Wesley Medical Center in Wichita, KS, the cash price of $934.00 is significantly higher than the state average, which is approximately 2.9 times the Medicare benchmark rate of $95.19. While commercial insurance plans like United and Health Partners Of Kansas have negotiated rates ranging from $141 to $467, these amounts often exceed the cash price for patients with high-deductible plans who have not yet met their coverage thresholds. In such cases, paying the cash rate directly can be more cost-effective than relying on insurance, as the negotiated ceiling may still be higher than the self-pay amount. Patients should verify their specific deductible status and ask the facility about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not paying more than necessary.
The facility's negotiated rates vary widely across payers, with the lowest allowed amount being $54 from Blue Cross Blue Shield and the highest at $841 from Multiplan. It is important to note that being in-network does not guarantee the lowest possible price, as different insurers contract at different levels; some in-network hospitals charge significantly more than others for the same service. To avoid unexpected costs, patients should request an itemized bill and compare the final charges against the Medicare benchmark rather than the hospital's full chargemaster list. Additionally, if you receive a bill that includes services from out-of-network providers, you may be eligible for protections under the No Surprises Act, which prevents balance billing for emergency and non-emergency care at in-network facilities. Always confirm your plan's specific coverage details and ask for a written estimate before your appointment.