Office visit, established patient (20-29 min)
Facility: Ellinwood District Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $63
- Cash Discount Price: $77
- vs. Medicare Baseline: 0.66x 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 | $49 - $140 | 51% |
| Cigna | $49 - $140 | 51% |
| Blue Cross Blue Shield | $49 - $140 | 51% |
| Aetna | $49 - $140 | 51% |
| Humana | $49 - $140 | 51% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, the gross charge is $90.00, while the cash median price is $77.00. If you have a high-deductible plan, paying the cash price of $77.00 upfront may be more cost-effective than using insurance, as the negotiated rates for major payers like UnitedHealthcare, Cigna, and Blue Cross Blue Shield range from $49.00 to $140.00. It is important to note that these negotiated rates include administrative costs for claims processing and can sometimes exceed the cash price. Before scheduling, you should explicitly ask the hospital for their "self-pay" or "prompt-pay" discount, which can reduce the bill by 20% to 50% if paid in full within 30 days.
The facility, Ellinwood District Hospital, is a Critical Access Hospital in Kansas, and the data reflects the 2026-06 billing vintage. While specific county or state average comparisons were not provided in the dataset, the cash median of $77.00 serves as a direct benchmark for out-of-pocket costs. If you choose to use insurance, be aware that the Medicare amount for this service is $95.19, which is higher than the cash price. To ensure you are not overcharged, request an itemized bill to verify that no services were unbundled or double-billed, and always confirm your deductible status before receiving care to avoid unexpected balance billing.