Office visit, established patient (20-29 min)
Facility: Jewell County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $105
- Cash Discount Price: $89
- vs. Medicare Baseline: 1.10x 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 |
|---|---|---|
| Rural Carriers - All Plans | $73 - $161 | 77% |
| Aetna | $77 - $170 | 81% |
| Meritain - All Plans | $77 - $170 | 81% |
| Midlands Choice - All Plans | $82 - $180 | 86% |
| First Health - All Plans | $82 - $180 | 86% |
| UnitedHealthcare | $82 - $180 | 86% |
| Cigna | $82 - $180 | 86% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient (20-29 minutes), the gross charge at Jewell County Hospital in Mankato, KS, is $118.00. This facility, a Critical Access Hospital owned by the local government, has a cash median of $89.00 and a negotiated median of $105.00. While the gross charge is significantly higher than the cash rate, it is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures. In this specific case, the cash price of $89.00 is lower than the facility's negotiated rate of $105.00, meaning patients with high-deductible plans might save money by paying cash directly, provided they qualify for the cash rate. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the higher insurance negotiated amount.
The pricing for this service is benchmarked against Medicare, which sets a fixed rate of $95.19 for this procedure. The facility's gross charge of $118.00 represents a markup of 1.1 times the Medicare amount, which is consistent with typical commercial pricing dynamics where rates can range from 200% to 300% of Medicare. It is crucial for consumers to avoid using the hospital's full chargemaster list as a benchmark for savings, as these inflated figures do not reflect actual costs. Instead, comparing the final allowed amount to the Medicare rate provides a clearer picture of value. If a patient receives a bill that appears to include balance