Office visit, established patient (20-29 min)
Facility: Logan County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $130
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.37x 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 | $38 - $133 | 40% |
| Medicaid / KanCare | $46 - $300 | 48% |
| UnitedHealthcare | $55 | 58% |
| Humana | $64 - $127 | 67% |
| Health Partners - All Plans | $142 - $285 | 149% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit with an established patient lasting 20–29 minutes, Logan County Hospital in Oakley, KS, lists a gross charge of $225.00. This amount is significantly higher than the Medicare benchmark of $95.19, which serves as the federally validated baseline for the true cost of care. While the facility's cash median price of $58.00 is lower than the gross charge, it remains above the Medicare rate. Commercial insurance payers negotiate rates that vary widely; for instance, Medicaid/KanCare plans may pay up to $300, while UnitedHealthcare pays a flat $55. Because these negotiated rates often exceed the cash price, patients with high-deductible plans might find paying the cash median of $58.00 directly more cost-effective than relying on insurance, provided they have not yet met their deductible.
Patients should be aware that the facility's gross charge of $225.00 is inflated to make discounts appear larger, so savings should only be calculated against the Medicare rate rather than the list price. The median negotiated rate across payers is $130.00, which is still higher than the cash option. To minimize costs, individuals should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid upfront. Additionally, since this is a Critical Access Hospital with government-local ownership, patients should request a full itemized bill before payment to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain