Office visit, established patient (20-29 min)
Facility: Clara Barton Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $102
- Cash Discount Price: $90
- vs. Medicare Baseline: 1.07x 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 | $67 | 70% |
| 6 Degrees Health - All Plans | $78 - $102 | 82% |
| Wppa-All Plans | $90 - $116 | 95% |
| Aetna | $101 - $130 | 106% |
| UnitedHealthcare | $101 - $130 | 106% |
| Phcs - All Plans | $101 - $130 | 106% |
| Hlth Partners Of Ks-All Plans | $103 - $133 | 108% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit with an established patient lasting 20 to 29 minutes, Clara Barton Hospital in Hoisington, KS, lists a gross charge of $129.00. The facility's cash median rate is $90.00, which is lower than the negotiated rates paid by insurance carriers ranging from $67 to $133 depending on the plan. While the median negotiated amount across payers is $102.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $90.00. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to direct cash payments.
When evaluating this rate against federal benchmarks, the facility's Medicare amount of $95.19 serves as the objective baseline for pricing. The gross charge of $129.00 represents a markup relative to this federal standard, illustrating how commercial rates can differ significantly from the true cost of care. Patients should be aware that balance billing is generally prohibited for emergency services and non-emergency care at in-network facilities under the No Surprises Act, though unexpected charges can still occur with ancillary services. To ensure the most accurate pricing, consumers are encouraged to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through a formal written dispute.