Office visit, established patient (20-29 min)
Facility: Cheyenne County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $81
- Cash Discount Price: $100
- vs. Medicare Baseline: 0.85x 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 | $38 - $67 | 40% |
| Firstguard - All Plans | $41 - $179 | 43% |
| Tricare | $55 - $289 | 58% |
| UnitedHealthcare | $55 - $289 | 58% |
| First Health - All Plans | $56 - $157 | 59% |
| Healthy Blue Mcr Adv | $57 - $289 | 60% |
| Aetna | $57 - $289 | 60% |
| Choice Care - All Plans | $58 - $289 | 61% |
| Wppa - All Plans | $61 - $202 | 64% |
| Providers Care-All Plans | $64 - $336 | 67% |
| Cpm - All Plans | $65 - $213 | 68% |
| Preferred Hc - All Plans | $65 - $213 | 68% |
| Midlands Choice - All Plans | $66 - $217 | 69% |
| Health Partners - All Plans | $67 - $220 | 70% |
| Ppo Next - All Plans | $67 - $220 | 70% |
| Integrated Hp - All Plans | $67 - $220 | 70% |
| Unicare - All Plans | $67 - $220 | 70% |
| Childrens Mercy - All Plans | $68 - $224 | 71% |
| Healthy Blue Mcaid - All Other Plans | $68 - $224 | 71% |
| Healthwave Mcaid - All Plans | $68 - $224 | 71% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, Cheyenne County Hospital in St. Francis, KS, lists a gross charge of $86.00. While the facility's cash median rate is $100.00, the actual amount paid by insurance varies significantly by plan, ranging from a low of $38.00 with Blue Cross Blue Shield to a high of $289.00 with Tricare and UnitedHealthcare. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final balance by offering immediate liquidity incentives that bypass standard claims processing fees.
When evaluating the cost of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's inflated list price. The Medicare amount for this code is $95.19, which serves as a scientifically validated baseline for the true cost of care. Commercial negotiated rates often average between 200% and 300% of Medicare, though fair pricing is typically defined as 120% to 150% of this amount. For instance, the highest negotiated rates observed in this dataset reach $289.00, which significantly exceeds the Medicare baseline and highlights the importance of verifying allowed amounts before scheduling. Patients should also be aware of balance billing risks if receiving out-of-network care, as the No Surprises Act provides federal protections against unexpected bills for emergency and non-emergency services at in-network facilities.