Office visit, established patient (20-29 min)
Facility: Ashland Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $120
- Cash Discount Price: $92
- vs. Medicare Baseline: 1.26x 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 | $29 - $62 | 30% |
| Compalliance-All Plans | $70 - $149 | 74% |
| Health Partners Of Kansas-All Plans | $75 - $158 | 79% |
| Multiplan-All Plans | $86 - $182 | 90% |
| Aetna | $88 - $186 | 92% |
| Healthy Blue Mcr Adv - All Other Plans | $110 - $412 | 116% |
| Medicaid / KanCare | $110 - $252 | 116% |
| Medica Mcare - All Plans | $110 - $412 | 116% |
| UnitedHealthcare | $110 - $412 | 116% |
| Medicare (plans) | $110 - $412 | 116% |
| Health Choice-All Plans | $110 - $412 | 116% |
| Providers Care (Wppa)-All Plans | $132 - $279 | 139% |
Consumer Guidance & Cost Commentary
For the CPT code 99213 representing an office visit with an established patient lasting 20 to 29 minutes, Ashland Health Center in Ashland, KS, lists a cash median price of $92.00 and a median negotiated rate of $120.00. While the facility's cash price is notably lower than the gross charge of $115.00, patients should be aware that commercial insurance plans often pay significantly higher negotiated rates, with some carriers like Healthy Blue Mcr Adv and UnitedHealthcare having maximum allowed amounts reaching $412.00. In this specific case, the cash price of $92.00 is lower than the median negotiated rate of $120.00, meaning patients with high-deductible plans or those who have not yet met their out-of-pocket maximum may save money by paying cash directly, provided they confirm the facility accepts self-pay discounts.
To ensure you are receiving the most accurate pricing, it is critical to request an itemized bill before finalizing payment, as summary bills often obscure individual charges and potential errors. If you choose to use insurance, remember that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, but you must still verify your specific plan's allowed amount, which varies widely among the 12 payers listed for this service. Always ask the billing department about prompt-pay discounts before scheduling your visit, as paying upfront can sometimes reduce the total cost further than the standard cash price, and ensure you receive a written audit dispute if any charges appear incorrect on your statement.