Office visit, established patient (20-29 min)
Facility: Holton Community Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $50
- Cash Discount Price: $83
- vs. Medicare Baseline: 0.53x 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 |
|---|---|---|
| UnitedHealthcare | $21 - $400 | 22% |
| Humana | $21 - $214 | 22% |
| Aetna | $21 - $400 | 22% |
| Kansas Superior Select - All Plans | $22 - $216 | 23% |
| Preferred Health Freedom | $33 - $332 | 35% |
| Preferred Health Professionals | $33 - $332 | 35% |
| Preferred Health Fn Select - All Other Plans | $33 - $332 | 35% |
| Wppa Providers - All Plans | $38 - $380 | 40% |
| Blue Cross Blue Shield | $38 - $67 | 40% |
| Medicaid / KanCare | $40 - $400 | 42% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Holton Community Hospital in Holton, Kansas, lists a gross charge of $111.00. While the facility's cash median rate is $83.00, which is lower than the gross charge, the negotiated rates for in-network payers vary significantly, ranging from $21 to $400 depending on the insurance plan. 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 verify with the hospital for potential "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
When evaluating the cost of this service, it is more accurate to compare rates against the Medicare benchmark rather than the hospital's gross list price. The Medicare amount for this procedure is $95.19, which serves as a scientifically validated baseline for the true cost of care. Commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the price well above this baseline. For instance, the median negotiated rate across payers is $50.00, while the median paid amount is $56.00. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services from out-of-network providers at in-network facilities under the No Surprises Act, and they should request a full itemized bill to ensure no unbundled codes or services not rendered are included in the final charge.