Office visit, established patient (20-29 min)
Facility: Nemaha Valley Community Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $74
- Cash Discount Price: $117
- vs. Medicare Baseline: 0.78x 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 |
|---|---|---|
| Humana | $37 - $60 | 39% |
| Aetna | $37 - $329 | 39% |
| Va Ccn - All Plans | $37 - $60 | 39% |
| Blue Cross Blue Shield | $38 - $133 | 40% |
| Celtic Comm Exch - All Plans | $41 - $329 | 43% |
| Partners Direct Health - All Plans | $44 - $71 | 46% |
| Multiplan - All Plans | $57 - $124 | 60% |
| Midlands Choice - All Plans | $80 - $129 | 84% |
| Health Partners - All Plans | $80 - $129 | 84% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Nemaha Valley Community Hospital in Seneca, KS, lists a gross charge of $130.00. The facility's cash median rate is $117.00, which is lower than the negotiated rates paid by most major payers listed in this report. For instance, while Aetna and Celtic Comm Exch - All Plans have negotiated rates as high as $329.00, the cash price remains significantly lower at $117.00. This demonstrates that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly can be more cost-effective than relying on insurance, as the insurer's negotiated rate often exceeds the cash price. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final amount owed.
The facility's pricing is also contextualized against federal benchmarks; the Medicare amount for this service is $95.19, and the facility's cash rate of $117.00 represents a markup of approximately 22% over the Medicare rate, which aligns with fair pricing standards rather than the typical 200% to 300% markup seen in some commercial settings. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request an itemized bill to ensure no unbundled codes or services not rendered are included. If a summary bill is received