Office visit, established patient (20-29 min)
Facility: Kiowa District Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $140
- Cash Discount Price: $116
- vs. Medicare Baseline: 1.47x 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 - $67 | 40% |
| UnitedHealthcare | $46 - $275 | 48% |
| Medicaid / KanCare | $46 - $261 | 48% |
| Tricare | $55 - $275 | 58% |
| Triwest-All Plans | $55 - $275 | 58% |
| Humana | $55 - $275 | 58% |
| Healthchoice-All Plans | $63 - $111 | 66% |
| Health Partners Of Ks-All Plans | $123 - $141 | 129% |
| Multiplan-All Plans | $132 - $150 | 139% |
| Gbs Insurance - All Plans | $132 - $150 | 139% |
| Aetna | $133 - $275 | 140% |
| Medicare (plans) | $133 - $265 | 140% |
| Providers Care (Wppa)-All Plans | $210 - $240 | 221% |
| Liberty Healthshare-All Plans | $226 - $467 | 237% |
Consumer Guidance & Cost Commentary
For the CPT code 99213 representing an office visit with an established patient (20-29 minutes), the gross charge at Kiowa District Hospital is $145.00. While the facility's cash median rate is $116.00, the negotiated rates paid by insurance plans range significantly higher, with the lowest allowed amount being $38.00 from Blue Cross Blue Shield and the highest reaching $467.00 from Liberty Healthshare-All Plans. It is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures; therefore, patients with high-deductible plans may find paying the cash median of $116.00 directly to the hospital more cost-effective than relying on insurance, which could result in higher out-of-pocket expenses if the deductible is not yet met.
The facility, a Critical Access Hospital in Kiowa, KS, operates under a government ownership model, and the Medicare benchmark for this service is $95.19. Commercial negotiated rates typically average between 200% and 300% of Medicare, though fair pricing is often defined as 120% to 150% of this baseline. To minimize potential balance billing, patients should verify their network status before scheduling, as out-of-network providers at in-network facilities are protected by the No Surprises Act from being billed for the difference between the chargemaster and the allowed amount. Additionally, patients should request a full itemized bill to identify any unbundled codes or services not rendered, and inquire about prompt-pay discounts, which can reduce the total cost by 20% to 50