Office visit, established patient (20-29 min)
Facility: Saint Luke'S South Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $128
- Cash Discount Price: $170
- vs. Medicare Baseline: 1.34x 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 | $44 - $95 | 46% |
| Transplants-Case Rates [5750] | $99 - $284 | 104% |
| Cigna | $104 - $199 | 109% |
| Medicaid / KanCare | $110 - $165 | 116% |
| Blue Cross Blue Shield | $128 - $189 | 134% |
| Aetna | $155 - $270 | 163% |
| First Health [5512] | $168 | 176% |
| Commercial-Contracted [8000] | $213 | 224% |
Consumer Guidance & Cost Commentary
For the CPT code 99213 representing an office visit with an established patient (20-29 minutes), Saint Luke's South Hospital in Overland Park, KS, lists a gross charge of $284.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $44 to $270, the cash median price is $170.00, which is notably lower than the median negotiated amount of $128.00. This pricing structure highlights a common billing dynamic where cash-pay options can be more cost-effective than insurance claims, particularly for patients with high-deductible plans where the insurer's allowed amount might exceed the cash price. The facility's cash rate of $170.00 is significantly higher than the state average for this service, suggesting that while the facility offers a discount for upfront payment, it remains above the typical regional benchmark for this procedure.
Patients should be aware that the facility's gross charge of $284.00 serves as the starting point for billing, but the actual cost depends heavily on payment method and timing. The Medicare benchmark for this service is $95.19, which acts as a reliable baseline for evaluating the facility's markup; the gross charge is approximately 3 times the Medicare rate, whereas the cash median is roughly 1.8 times the Medicare rate. To minimize costs, patients are encouraged to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid in full within 30 days. Additionally, if a patient has insurance,