Office visit, established patient (20-29 min)
Facility: Ellsworth County Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $125
- Cash Discount Price: $133
- vs. Medicare Baseline: 1.31x 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 |
|---|---|---|
| First Health - All Plans | $29 - $411 | 30% |
| Aetna | $29 - $411 | 30% |
| Humana | $30 - $434 | 32% |
| Cigna | $30 - $434 | 32% |
| UnitedHealthcare | $30 - $457 | 32% |
| Medicaid / KanCare | $32 - $457 | 34% |
| Coventry Mcaid-All Plans | $32 - $457 | 34% |
| Healthy Blue Mcaid- All Other Plans | $32 - $457 | 34% |
| Blue Cross Blue Shield | $36 - $76 | 38% |
| Providers Care-Wppa-All Plans | $48 - $686 | 50% |
| Triwest -All Plans | $55 - $258 | 58% |
| Va Ccn-All Plans | $55 - $258 | 58% |
| Healthy Blue Mcr Adv | $215 - $258 | 226% |
Consumer Guidance & Cost Commentary
For this office visit at Ellsworth County Medical Center, the cash price of $133.00 is identical to the median amount paid by insurance, indicating that self-pay rates are currently competitive with negotiated rates. While the facility's cash price matches the state average for this service, it is notably higher than the county average for similar visits, which typically ranges between $29 and $411 depending on the specific payer contract. Patients with high-deductible plans may find paying the full cash price of $133.00 more advantageous than using insurance, as the negotiated rates for many payers (such as UnitedHealthcare and Humana) can exceed $400, potentially leaving patients responsible for significant out-of-pocket costs after deductibles.
To minimize costs, patients should explicitly request a "prompt-pay" discount before scheduling, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead of insurance claims. Additionally, since this is a Critical Access Hospital in Kansas, the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, though patients should still verify their specific plan details to ensure they are not subject to unexpected charges. It is also recommended to obtain a full itemized bill before paying, as summary invoices may obscure unbundled codes or services not rendered, allowing you to dispute any errors formally in writing.