Office visit, established patient (20-29 min)
Facility: Graham County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $65
- Cash Discount Price: $104
- vs. Medicare Baseline: 0.68x 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 | $39 - $75 | 41% |
| Medicaid / KanCare | $46 | 48% |
| Celtic Commercial-All Other Plans | $58 - $65 | 61% |
| Medicare (plans) | $59 | 62% |
| Blue Cross Blue Shield | $67 - $76 | 70% |
| Wppa (Providers Care)-All Plans | $75 - $86 | 79% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Graham County Hospital in Hill City, KS, lists a gross charge of $104.00. This amount serves as the baseline before any insurance adjustments or discounts are applied. While the facility offers a cash price of $104.00, patients with high-deductible plans or those without insurance may find this rate competitive, as paying cash upfront can sometimes be cheaper than the negotiated rates commercial insurers charge, which often include administrative overhead. It is important to note that the facility is a Critical Access Hospital owned by the local government, and while specific self-pay or prompt-pay discounts are not explicitly detailed in this dataset, patients should always inquire directly with the billing department before scheduling to confirm if immediate payment qualifies for additional fee reductions.
When compared to standard benchmarks, the facility's pricing structure reveals significant variation depending on the payer. The median negotiated rate across payers is $65.00, which is notably lower than the gross charge, reflecting the contractual agreements that limit out-of-network billing. However, individual payer ranges vary widely; for instance, UnitedHealthcare plans see a range of $39 to $75, while Wppa (Providers Care) ranges from $75 to $86. These figures are derived from 6 different payer plans and should be viewed alongside the Medicare benchmark of $95.19, which acts as a cost-based standard for evaluating fair pricing. Since the facility is located in a Critical Access Hospital setting, patients should be aware that federal protections like the No Surprises Act may apply to prevent balance billing for out