Office visit, established patient (20-29 min)
Facility: Kiowa County Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $85
- Cash Discount Price: $81
- vs. Medicare Baseline: 0.89x 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 - $445 | 40% |
| Medicaid / KanCare | $46 - $200 | 48% |
| UnitedHealthcare | $46 - $434 | 48% |
| Humana | $50 - $445 | 53% |
| Celtic Comml Exchange-All Other Plans | $55 - $445 | 58% |
| Providrs Care/Wppa-All Plans | $55 - $300 | 58% |
| Medica Prime Mcare Cost-All Plans | $62 - $445 | 65% |
| Aetna | $62 - $445 | 65% |
| Health Partners Of Ks-All Plans | $62 - $176 | 65% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, the facility's cash median rate is $81.00, while the median negotiated rate across nine payers is $85.00. This cash price is notably lower than the Medicare benchmark of $95.19, which serves as the objective baseline for healthcare costs in this region. Patients with high-deductible plans may find paying the $81.00 cash rate more cost-effective than relying on insurance, as the negotiated rates of $38.00 to $445.00 vary significantly by insurer and often exceed the cash price due to administrative overhead and contract structures. It is important to note that while the facility is a Critical Access Hospital in Greensburg, KS, with government-local ownership, the specific negotiated rates depend entirely on the individual insurance plan's contract terms.
Before scheduling, patients should verify their specific plan's allowed amount, as commercial rates can range widely from $38.00 to $445.00 depending on the payer. If you choose to pay out-of-pocket, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the $81.00 cash median. Additionally, be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services at in-network facilities, unexpected charges can still occur if ancillary services like labs or emergency physicians are out-of-network. To ensure accuracy, always request a full itemized bill before paying, as summary invoices may obscure errors or unbundled codes that could otherwise be