Office visit, established patient (20-29 min)
Facility: Stevens County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $195
- Cash Discount Price: $224
- vs. Medicare Baseline: 2.05x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 205% of the Medicare baseline (a markup of 105%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $36 - $38 | 38% |
| Humana | $83 | 87% |
| Aetna | $85 - $224 | 89% |
| First Health - All Plans | $202 | 212% |
| Wppa - All Plans | $213 | 224% |
| Medicaid / KanCare | $224 | 235% |
Consumer Guidance & Cost Commentary
For this office visit at Stevens County Hospital in Hugoton, Kansas, the cash price is $224.00, which matches the facility's gross chargemaster rate and the median amount paid by Medicaid. While the facility is a Critical Access Hospital with a government-local ownership structure, the cash rate is notably higher than the state average for this service, which is $95.19. Patients with high-deductible plans or those without insurance may find paying the cash price directly more cost-effective than using insurance, as the negotiated rates for major payers like Aetna and First Health range from $83 to $224, often exceeding the cash amount. It is important to verify your specific plan's allowed amount before scheduling, as assuming that being in-network guarantees the lowest price can lead to unexpected costs if your deductible has not yet been met.
To minimize potential debt, consumers should proactively request a prompt-pay discount or self-pay rate from the hospital before check-in, as these upfront payments can bypass costly insurance billing cycles and administrative fees. If you do receive a bill, always demand a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected. Furthermore, if you are billed for services from out-of-network providers at this in-network facility, the No Surprises Act may protect you from balance billing for emergency care and non-emergency services, so you should dispute any surprise charges in writing rather than paying immediately out of fear.