Office visit, established patient (20-29 min)
Facility: F W Huston Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $72
- Cash Discount Price: $136
- vs. Medicare Baseline: 0.76x 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 |
|---|---|---|
| Aetna | $22 - $206 | 23% |
| Humana | $24 - $217 | 25% |
| Cigna | $26 - $234 | 27% |
| Blue Cross Blue Shield | $38 - $133 | 40% |
Consumer Guidance & Cost Commentary
For this office visit at F W Huston Medical Center in Winchester, KS, the cash price of $136.00 is notably lower than the facility's negotiated rates with major insurers like Aetna, Humana, and Cigna, which range from $22 to $234 depending on the specific plan. While the median amount paid by insurance members is $49.00, this figure reflects the patient's specific deductible and copay status rather than the full negotiated fee; in many cases, paying the cash price upfront can be more cost-effective for patients with high deductibles, as the cash rate often falls below the insurer's allowed amount. It is important to note that this facility is a Critical Access Hospital, and while the cash price is competitive, patients should verify if their specific plan has a lower allowed amount before scheduling to ensure they are not paying more than necessary.
The facility's pricing structure is anchored by a Medicare benchmark of $95.19, which serves as a reliable baseline for evaluating commercial rates. Although the data does not provide explicit county or state average comparisons for this specific CPT code, the facility's cash rate of $136.00 represents a significant markup over the Medicare amount, a common dynamic in the healthcare industry where commercial rates often exceed federal benchmarks due to administrative costs and profit margins. To maximize savings, patients should inquire directly with the billing department about "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within 30 days, effectively bypassing the administrative overhead associated with insurance claims. Additionally, since this is a voluntary non-profit facility, patients should request an itemized