Office visit, established patient (20-29 min)
Facility: Overland Park Reg Med Ctr
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $240
- Cash Discount Price: $667
- vs. Medicare Baseline: 2.52x 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 252% of the Medicare baseline (a markup of 152%). 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 | $42 - $284 | 44% |
| Nhc Advantage | $61 - $235 | 64% |
| Healthyblue | $64 - $247 | 67% |
| Coventry | $70 - $497 | 74% |
| United | $80 - $556 | 84% |
| Aetna | $96 - $630 | 101% |
| Humana | $111 - $138 | 117% |
| Universal Healthcare | $112 - $433 | 118% |
| Coventry Kc Mo | $131 - $507 | 138% |
| College Park Family Care Center | $138 - $531 | 145% |
| Oha Network | $160 - $618 | 168% |
| Multiplan | $170 - $989 | 179% |
| Corvel Corporation | $208 - $803 | 219% |
| Triwest Health Alliance | $240 - $927 | 252% |
| Cco, Inc. | $240 - $927 | 252% |
| Focus Healthcare Mgmt, Inc | $240 - $927 | 252% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, the cash price at Overland Park Reg Med Ctr is $667.00. This cash rate is significantly higher than the state average for Kansas, which is approximately $240.00. While commercial insurance plans like Aetna and United have negotiated rates ranging from $96 to $630 and $80 to $556 respectively, these amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the insurance negotiated rate could be higher than the out-of-pocket cash cost. To secure the lowest possible payment, it is recommended to contact the facility directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if settled upfront.
When using insurance, it is important to understand that the facility's gross charge of $667.00 is not the amount billed to the patient; instead, the facility is contractually bound by negotiated rates that cap the charge for in-network members. However, patients should be aware of balance billing risks if they receive out-of-network services, such as certain lab tests or ancillary procedures, which could result in bills for the difference between the provider's full rate and the insurance allowed amount. To avoid unexpected costs, consumers should request a full itemized bill before paying and verify that all services rendered are correctly coded. Additionally, comparing the facility's pricing to the Medicare benchmark of $95.19 reveals that the cash rate represents a