Office visit, established patient (20-29 min)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $48
- Cash Discount Price: $89
- vs. Medicare Baseline: 0.50x 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 |
|---|---|---|
| UnitedHealthcare | $42 - $46 | 44% |
| Medicaid / KanCare | $44 - $48 | 46% |
| Aetna | $44 - $48 | 46% |
| Tricare | $74 | 78% |
| Providrs Care | $80 | 84% |
| Blue Cross Blue Shield | $145 - $152 | 152% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Ascension Via Christi Hospital Manhattan, Inc. in Manhattan, KS, lists a gross charge of $222.00. While the facility offers a cash median price of $89.00, which is significantly lower than the negotiated rates paid by insurers, patients should be aware that commercial insurance plans often pay higher amounts due to administrative costs and contract structures. For instance, UnitedHealthcare and Medicaid/KanCare plans have negotiated ranges between $42 and $48, whereas Blue Cross Blue Shield plans pay up to $152. Because cash payments can sometimes be cheaper than the insurance negotiated rate, especially for those with high-deductible plans, it is advisable to confirm "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling to ensure you are not paying the full chargemaster amount.
This service is benchmarked against federal standards, with a Medicare amount of $95.19. The facility's cash rate of $89.00 is notably lower than the Medicare benchmark, suggesting a competitive pricing structure for direct payers. However, commercial payers like Tricare and Providrs Care have fixed negotiated rates of $74 and $80 respectively, which are higher than the cash price but lower than the Blue Cross Blue Shield maximum. Since over 80% of hospital bills often contain errors or unbundled charges, consumers should request a detailed, itemized bill rather than accepting a summary invoice. If you receive a bill that exceeds the negotiated or cash rates, you may be subject to balance billing if you