Office visit, established patient (20-29 min)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $186
- Cash Discount Price: $187
- vs. Medicare Baseline: 1.95x 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 |
|---|---|---|
| Tricare | $149 - $357 | 157% |
| Humana | $169 - $406 | 178% |
| Aetna | $172 - $446 | 181% |
| Hpk-All Plans | $177 - $424 | 186% |
| UnitedHealthcare | $177 - $424 | 186% |
| Medicaid / KanCare | $186 - $446 | 195% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, the cash price at Medicine Lodge Memorial Hospital is $187.00, which matches the state average for this service. While commercial insurance plans like Aetna and Humana have negotiated rates ranging from $169 to $446, these amounts often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate of $187.00 directly, as the insurance negotiated rates can sometimes be significantly higher than the out-of-pocket cash amount. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated rate may not be covered until that threshold is met.
To ensure you are receiving fair pricing, compare the facility's rates against the Medicare benchmark of $95.19, which serves as the scientifically validated baseline for healthcare costs in this region. The hospital's cash rate of $187.00 represents a markup of 2.0 times the Medicare amount, which falls within the typical range for commercial pricing. Additionally, you should inquire about "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead associated with insurance claims. Always request an itemized bill before paying to avoid errors or double-charging, and remember that the No Surprises Act protects you from balance billing for emergency services at in-network facilities.