Office visit, established patient (20-29 min)
Facility: Grisell Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $131
- Cash Discount Price: $124
- vs. Medicare Baseline: 1.38x 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 | $64 | 67% |
| UnitedHealthcare | $86 - $221 | 90% |
| Medicaid / KanCare | $115 - $221 | 121% |
| Humana | $221 - $316 | 232% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient at Grisell Memorial Hospital in Ransom, KS, the facility's cash price of $124.00 is lower than the state average, offering a potential savings for patients with high-deductible plans or those paying out-of-pocket. While the facility's negotiated rate of $131.00 is slightly higher than the cash price, it aligns closely with the median negotiated rate across Kansas, suggesting the facility is pricing competitively within the state market. It is important to note that commercial insurance payers like UnitedHealthcare and Medicaid/KanCare have negotiated rates ranging from $86 to $221, which often exceed the cash price due to administrative costs and contract structures. Patients should verify their specific plan's deductible status before scheduling, as paying the cash rate upfront may result in immediate savings if their insurance would otherwise cover a higher negotiated amount.
The Medicare benchmark for this service is $95.19, which serves as a reliable baseline for evaluating the facility's pricing markup. The facility's cash rate of $124.00 represents a 30% increase over the Medicare amount, which falls within the typical range of fair pricing (120% to 150% of Medicare) and is significantly lower than the commercial negotiated rates seen with payers like Humana. To ensure you receive the best possible rate, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by 20% to 50% if paid in full before services are rendered. Additionally, if you receive a bill after using insurance, request a full itemized statement to review