Office visit, established patient (20-29 min)
Facility: Hamilton County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $92
- Cash Discount Price: $103
- vs. Medicare Baseline: 0.97x 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 |
|---|---|---|
| Blue Cross Blue Shield | $18 - $133 | 19% |
| First Health Coventry - All Plans | $21 - $122 | 22% |
| Cigna | $24 - $137 | 25% |
| UnitedHealthcare | $24 - $137 | 25% |
| Va Ccn - All Plans | $92 - $115 | 97% |
| Aetna | $156 - $366 | 164% |
Consumer Guidance & Cost Commentary
For this established patient office visit at Hamilton County Hospital in Syracuse, KS, the cash price is $103.00, which matches the facility's median negotiated rate of $92.00 and the Medicare benchmark of $95.19. While the gross charge listed is $103.00, patients should be aware that commercial insurance negotiated rates for this service range from $18 to $137 across six different payers, with some plans like Aetna showing higher negotiated amounts between $156 and $366. Because the cash price is lower than the median negotiated rate of $122.00, paying out-of-pocket may result in immediate savings for those with high-deductible plans or those who have already met their deductible. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final amount owed.
When reviewing your bill, ensure you request a full itemized statement rather than accepting a summary invoice that obscures individual charges, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Comparing this facility's pricing to the broader market, the low and high negotiated rates for this code among payers like Blue Cross Blue Shield ($18–$133) and Cigna ($24–$137) highlight significant variation in allowed amounts. Since Medicare rates serve as a scientifically validated baseline representing the true cost of care, the fact that the cash price aligns closely with the Medicare amount of $95.19 suggests fair pricing relative to federal standards. Always