Office visit, established patient (20-29 min)
Facility: Kansas Heart Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $48
- Cash Discount Price: $132
- 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 | $45 - $101 | 47% |
| Medicaid / KanCare | $46 | 48% |
| Celtic Mcaid - All Other Plans | $46 | 48% |
| Soonerselect Mcaid - All Plans | $46 | 48% |
| Blue Cross Blue Shield | $46 - $77 | 48% |
| Tricare | $47 | 49% |
| Aetna | $66 | 69% |
| Wppa - All Plans | $86 | 90% |
| Multiplan - All Plans | $96 | 101% |
Consumer Guidance & Cost Commentary
For this office visit at Kansas Heart Hospital in Wichita, the cash price of $132.00 is lower than the facility's negotiated rates with most major payers, including UnitedHealthcare and Blue Cross Blue Shield, which range from $45 to $101. While the median amount paid by insurers is $82.00, patients with high-deductible plans may find the cash price more affordable, especially since the facility offers a prompt-pay discount for upfront payment. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still verify their specific plan's allowed amount before scheduling to ensure they are not facing unexpected costs.
When evaluating the cost of this service, it is more accurate to compare the cash price against the Medicare benchmark of $95.19 rather than the hospital's gross charge of $209.00, as the latter is inflated to make discounts appear larger. The facility's negotiated rate of $48.00 sits below the Medicare amount, indicating a favorable contract for in-network members, though the cash price remains competitive for self-pay patients. To avoid errors or double-charging, consumers should request a full itemized bill before paying, as summary invoices often obscure individual charges, and always confirm whether the facility offers a self-pay discount prior to check-in to maximize savings.