Office visit, established patient (20-29 min)
Facility: Kansas City Orthopaedic Institute
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $173
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.82x 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 |
|---|---|---|
| Blue Cross Blue Shield | $66 - $300 | 69% |
| Cigna | $135 | 142% |
| Medica | $172 - $340 | 181% |
| UnitedHealthcare | $263 | 276% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, the facility's gross charge is $230.00. While the facility is owned by physicians and located in Leawood, Kansas, the data indicates that cash payments are not available for this service. Instead, patients with insurance coverage can expect negotiated rates ranging from $66 to $340 depending on their specific plan with carriers like Blue Cross Blue Shield, Cigna, Medica, or UnitedHealthcare. It is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures; however, since cash rates are null for this procedure, patients should verify if their specific plan has a lower allowed amount than the facility's negotiated ceiling to minimize out-of-pocket costs.
The facility's pricing is benchmarked against Medicare, which sets a fixed rate of $95.19 for this code. The data shows a multiplier of 1.8 relative to Medicare, indicating that the facility's pricing structure is significantly higher than the federal baseline. While the report does not provide specific county or state average comparisons for this exact code, the wide variance in negotiated rates across different payers highlights the importance of checking your specific plan details before scheduling. Patients should also inquire directly with the hospital about potential "self-pay" or "prompt-pay" discounts, as these upfront payment incentives can sometimes reduce the final amount owed, particularly if the negotiated rate exceeds what a patient might otherwise pay under their deductible.