Office visit, established patient (20-29 min)
Facility: Providence Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $87
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.91x 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 |
|---|---|---|
| Early Detection Works | $87 | 91% |
Consumer Guidance & Cost Commentary
This office visit at Providence Medical Center in Kansas City, KS, carries a negotiated rate of $87.00, which matches the lowest and highest payment reported for this specific CPT code among the single payer, Early Detection Works. While the facility's median negotiated rate is $87.00, the Medicare benchmark for this service is $95.19, indicating that the commercial rate is slightly below the federal baseline. For patients with high-deductible plans, the cash price is not listed, but it is important to note that cash-pay options can sometimes be cheaper than insurance negotiated rates if the insurer's allowed amount exceeds the cash price. Patients should verify with the hospital whether "self-pay" or "prompt-pay" discounts are available before scheduling to potentially reduce the final cost.
The facility is an acute care hospital owned by a voluntary non-profit church, and the billing data reflects a vintage of June 2026. Although the data does not provide explicit county or state average comparisons for this specific code, the Medicare amount of $95.19 serves as a critical benchmark for evaluating the facility's pricing markup. If a patient receives care from an out-of-network provider at this facility, they should be aware of federal protections under the No Surprises Act, which generally bans balance billing for emergency and non-emergency services at in-network facilities. To ensure accuracy, patients should request a full itemized bill to review specific CPT codes and avoid paying for services that were never rendered or that were incorrectly bundled.