Office visit, established patient (20-29 min)
Facility: Rawlins County Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $161
- Cash Discount Price: $157
- vs. Medicare Baseline: 1.69x 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 | $133 | 140% |
| UnitedHealthcare | $152 - $231 | 160% |
Consumer Guidance & Cost Commentary
For this office visit at Rawlins County Health Center in Atwood, KS, the cash price of $157.00 is significantly lower than the negotiated rates charged by UnitedHealthcare, which range from $152 to $231 depending on the specific plan. While Blue Cross Blue Shield has a fixed negotiated rate of $133, patients with high-deductible plans may find paying the cash price of $157.00 more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash rate. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price, sometimes reaching 200% to 300% of the Medicare benchmark of $95.19 for this service.
To minimize potential costs, patients should explicitly ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50%. If you choose to use insurance, be aware that balance billing could occur if you are out-of-network, where the provider bills the difference between their full charge and the insurance allowed amount; however, the No Surprises Act protects you from such surprise bills for emergency care and non-emergency services at in-network facilities. Furthermore, if you receive a bill, always request a full itemized audit rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered that can be disputed to lower your final payment.