Office visit, established patient (20-29 min)
Facility: Kearny County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $115
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.21x 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 |
|---|---|---|
| Point C | $101 - $115 | 106% |
| Allied Benefit - Aso | $101 | 106% |
| UnitedHealthcare | $101 - $1,131 | 106% |
| Insurance Administrator Of Ame | $101 - $115 | 106% |
| Community Care Health Plan Of | $101 - $157 | 106% |
| Kansas Solutions | $101 - $961 | 106% |
| Blue Cross Blue Shield | $101 - $740 | 106% |
| Allied Benefit - Bpo | $115 | 121% |
| Humana | $115 - $257 | 121% |
| Luminare Health | $115 | 121% |
| Meritain Health | $115 | 121% |
| Rocky Mountain Hospital&Medica | $115 - $157 | 121% |
| Benefit Plan Administrators | $115 | 121% |
| Wps Gha - Mac J5 Part A | $961 - $1,131 | 1010% |
Consumer Guidance & Cost Commentary
For this office visit at Kearny County Hospital in Lakin, KS, the negotiated rates for CPT code 99213 range from $101 to $1,131 across 14 different payers, with a median negotiated amount of $115. This median rate is notably higher than the state average of $80, suggesting that commercial insurance contracts in this area often exceed the baseline payment expected for this service. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that cash-pay options are not listed in the current data; however, it is always advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can sometimes result in lower costs than the standard insurance negotiated rates.
The Medicare benchmark for this procedure is $95.19, which serves as a reliable baseline for evaluating the facility's pricing structure. Since commercial negotiated rates frequently average between 200% and 300% of Medicare amounts, the $115 median rate here reflects a markup that is consistent with typical industry standards but still warrants scrutiny. Patients with high-deductible plans should consider that paying out-of-pocket might be more economical if the insurance allowed amount exceeds the cash price, though no cash price is currently available for this code. To avoid unexpected charges, consumers should request an itemized bill before paying, as summary invoices often obscure individual line items, and they should verify that any balance billing they receive complies with the No Surprises Act, particularly if they are receiving care from out-of-network providers at this in-network facility.