Office visit, established patient (20-29 min)
Facility: Rooks County Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $77
- Cash Discount Price: $105
- vs. Medicare Baseline: 0.81x 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 |
|---|---|---|
| Healthy Blue Mcaid - All Plans | $46 - $143 | 48% |
| Tricare | $55 - $67 | 58% |
| Veterans Admin - All Plans | $55 - $67 | 58% |
| Celtic Comm - All Other Plans | $58 - $74 | 61% |
| UnitedHealthcare | $63 - $128 | 66% |
| Preferred Benefits Admin | $64 - $128 | 67% |
| Preferred Hlthcare - All Other Plans | $64 - $136 | 67% |
| Celtic Mcr Adv | $64 - $67 | 67% |
| Blue Cross Blue Shield | $77 - $133 | 81% |
| Aetna | $90 - $128 | 95% |
| Health Partners - All Plans | $121 - $136 | 127% |
Consumer Guidance & Cost Commentary
For the CPT code 99213 representing an office visit with an established patient, the facility's cash price of $105.00 is notably lower than the gross charge of $140.00 and sits below the negotiated rates paid by most commercial payers, which range from $55.00 to $136.00. While the median negotiated amount across all payers is $77.00, the cash price of $105.00 is actually higher than this median negotiated figure, suggesting that for patients with high-deductible plans who have not yet met their coverage threshold, paying cash directly might result in a higher out-of-pocket cost than the insurance allowed amount. However, if a patient's insurance plan has a high deductible or does not cover this service, the cash price remains a fixed, predictable cost without the risk of balance billing, provided the patient requests a self-pay classification before scheduling.
The facility, a Critical Access Hospital in Plainville, KS, operates under a government ownership model, and its pricing is benchmarked against Medicare, which sets the standard rate for this service at $95.19. The cash price of $105.00 is approximately 10% higher than the Medicare amount, which is consistent with the typical markup seen in commercial pricing where negotiated rates often exceed 200% of the Medicare baseline. Patients should be aware that while the facility offers a median negotiated rate of $77.00, this amount is still higher than the cash price for many, meaning that for those without insurance or with limited coverage, the cash price of $105.00 may