Office visit, established patient (20-29 min)
Facility: Kansas Spine & Specialty Hospital, Llc
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $55
- Cash Discount Price: $125
- vs. Medicare Baseline: 0.58x 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 |
|---|---|---|
| Humana | $54 | 57% |
| Blue Cross Blue Shield | $55 - $56 | 58% |
| UnitedHealthcare | $55 - $66 | 58% |
| Aetna | $55 - $69 | 58% |
| Providrs Care Network | $55 | 58% |
| United Mine Workers Of America | $55 | 58% |
| Lantern Specialty Care | $88 | 92% |
Consumer Guidance & Cost Commentary
For this office visit to an established patient at Kansas Spine & Specialty Hospital, Llc in Wichita, the cash median price is $125.00, which is significantly lower than the facility's negotiated rates of $55.00 and the gross charge of $193.00. While the facility is an Acute Care Hospital owned by physicians, the cash price is notably higher than the Medicare benchmark of $95.19, suggesting that for patients with high-deductible plans, paying cash upfront might be more cost-effective than relying on insurance, which often results in higher out-of-pocket costs due to administrative markups. It is important to note that while the facility is in-network for seven major payers including Humana and UnitedHealthcare, the negotiated rates vary widely, ranging from $54 to $88 depending on the specific insurance plan, meaning a patient's actual cost could exceed the cash price if their deductible has not yet been met.
To ensure you are receiving the most accurate pricing, always request a full itemized bill before finalizing payment, as summary bills often obscure individual charges and may include unbundled codes or services not rendered. If you choose to use insurance, remember that the facility's gross charge of $193.00 is inflated compared to the Medicare rate, and commercial negotiated rates often include administrative overhead that pushes the price well above the true cost of care. Additionally, ask the billing department about prompt-pay discounts, which can reduce the total amount owed by 20% to 50% if you pay in full within a short window, effectively bypassing the costly claims processing cycle that insurance companies impose.