Office visit, established patient (20-29 min)
Facility: Lane County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $119
- Cash Discount Price: $120
- vs. Medicare Baseline: 1.25x 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 | $94 - $120 | 99% |
| Aetna | $94 - $119 | 99% |
| Medicaid / KanCare | $105 - $235 | 110% |
| Healthy Blue Mcaid | $105 - $125 | 110% |
| Healthy Blue Mcr Adv - All Other Plans | $105 - $235 | 110% |
| Wppa Providers-All Plans | $158 - $188 | 166% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit for an established patient lasting 20 to 29 minutes, the cash price at Lane County Hospital in Dighton, KS, is $120.00. This cash rate is notably higher than the state average for this procedure, which is $113.00. While patients with high-deductible plans might find the cash price attractive compared to some insurance negotiated rates, it is important to note that commercial insurance contracts often result in higher allowed amounts due to administrative overhead and contract dynamics. For instance, the median negotiated rate across payers is $119.00, and the gross chargemaster is $120.00. Patients should verify their specific plan's deductible status before assuming insurance will result in a lower out-of-pocket cost, as many plans require the full negotiated amount to be paid before coverage begins.
To minimize potential financial exposure, consumers should proactively request a prompt-pay discount or self-pay rate from the hospital before scheduling, as these upfront discounts can significantly reduce the final bill by bypassing costly insurance claims processing. Additionally, if you ever receive a bill for services rendered at an in-network facility by an out-of-network provider, you may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency services. If you do receive a surprise bill, do not pay it immediately; instead, request a formal itemized audit to identify errors such as unbundled codes or services not rendered, and dispute any balance billing with your insurer. Always demand a detailed, line-by-line statement rather than accepting a summary bill, as over 80% of hospital bills contain