Office visit, established patient (20-29 min)
Facility: Menorah Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $311
- Cash Discount Price: $1,177
- vs. Medicare Baseline: 3.27x 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 327% of the Medicare baseline (a markup of 227%). 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 | $11 - $344 | 12% |
| Nhc Advantage | $16 - $284 | 17% |
| Healthyblue | $17 - $299 | 18% |
| Coventry | $19 - $602 | 20% |
| Aetna | $22 - $764 | 23% |
| United | $22 - $674 | 23% |
| Universal Healthcare | $30 - $524 | 32% |
| Coventry Kc Mo | $35 - $614 | 37% |
| College Park Family Care Center | $37 - $644 | 39% |
| Oha Network | $43 - $749 | 45% |
| Multiplan | $46 - $1,198 | 48% |
| Corvel Corporation | $56 - $973 | 59% |
| Cco, Inc. | $65 - $1,123 | 68% |
| Focus Healthcare Mgmt, Inc | $65 - $1,123 | 68% |
| Triwest Health Alliance | $65 - $1,123 | 68% |
| Cigna | $69 - $1,198 | 72% |
| Humana | $111 - $138 | 117% |
Consumer Guidance & Cost Commentary
For this office visit at Menorah Medical Center in Overland Park, KS, the cash price is $1,177.00, which matches the facility's cash median. While the facility is an Acute Care Hospital with a Proprietary ownership structure, the data does not provide specific county or state average figures for comparison. It is important to note that commercial insurance negotiated rates for this service vary significantly, ranging from $11 to $1,380 across different payers. In many cases, the negotiated rate paid by an insurer exceeds the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly. To secure the lowest possible cost, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the total amount owed.
The Medicare benchmark for this procedure is $95.19, which serves as a critical baseline for evaluating pricing fairness. Commercial rates are often substantially higher than this federal standard; for instance, the highest negotiated rate in the dataset reaches $1,380, while the median negotiated rate is $311.00. Patients should be aware of the risk of balance billing if they receive care from out-of-network providers, where the hospital could bill the full chargemaster rate rather than the insurance allowed amount. Additionally, summary bills often obscure individual charges, so requesting a detailed, itemized audit is essential to identify errors, unbundled codes, or services not rendered. By comparing rates against the Medicare amount and verifying the status of their deductible, patients can make informed decisions that avoid unexpected financial burdens.