Office visit, established patient (20-29 min)
Facility: Stafford County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $110
- Cash Discount Price: $165
- vs. Medicare Baseline: 1.16x 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 |
|---|---|---|
| Va Ccn-All Plans | $55 - $220 | 58% |
| Health Partners-All Plans | $104 - $209 | 109% |
| Humana | $110 - $220 | 116% |
| UnitedHealthcare | $110 - $220 | 116% |
| Medica Mcr- All Plans | $110 - $220 | 116% |
Consumer Guidance & Cost Commentary
For the CPT code 99213 representing an established patient office visit lasting 20 to 29 minutes, Stafford County Hospital lists a gross charge of $165.00. While the facility's cash median rate is $165.00, which matches the Medicare benchmark of $95.19 at 120% of that rate, commercial insurance negotiated rates vary significantly. In-network payers such as Humana, UnitedHealthcare, and Medica Mcr have a median negotiated rate of $110.00, which is lower than the cash price but higher than the Medicare benchmark. Patients should note that commercial rates often include administrative overhead and contract premiums, meaning the cash price can sometimes be more affordable if the patient's insurance deductible is high or if the negotiated rate exceeds the cash amount.
It is important to verify your specific plan's allowed amount before scheduling, as in-network rates are not uniform across all providers. For this service, the lowest negotiated rate found is $55.00 with Va Ccn-All Plans, while the highest is $220.00. If you are paying out-of-pocket, you may qualify for a prompt-pay discount by requesting a self-pay classification prior to check-in, which can reduce the $165.00 cash rate further. Additionally, since this facility is a Critical Access Hospital in KS with a government-local ownership structure, you should request an itemized bill to ensure no services were bundled or double-charged, as over 80% of hospital bills contain errors that can be corrected through a formal written audit.