Office visit, established patient (20-29 min)
Facility: Great Plains Of Sabetha
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $118
- Cash Discount Price: $131
- vs. Medicare Baseline: 1.24x 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 | $36 - $181 | 38% |
| Celtic Mcr Adv | $44 - $330 | 46% |
| Aetna | $45 - $334 | 47% |
| UnitedHealthcare | $46 - $181 | 48% |
| Medicaid / KanCare | $46 - $181 | 48% |
| Celtic Comm Exchange-All Other Plans | $55 - $413 | 58% |
| Great West Healthcare-All Plans | $72 - $154 | 76% |
| Century/Wppa/Providers-All Plans | $81 - $172 | 85% |
| Humana | $81 - $172 | 85% |
| Multiplan-Phcs-All Plans | $81 - $172 | 85% |
| Cigna | $81 - $172 | 85% |
| Federated Mutual Ins-All Plans | $82 - $174 | 86% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, the facility in Sabetha, Kansas, lists a gross charge of $131.00. This amount aligns exactly with the cash median of $131.00 and the Medicare benchmark of $95.19, indicating a markup of 1.2 times the Medicare rate. While the facility offers a negotiated rate of $118.00 for in-network payers, the cash price remains competitive and potentially more affordable for patients with high-deductible plans or those without insurance, as the cash rate is lower than the median negotiated amount of $118.00. Patients should verify their specific plan's deductible status before relying on insurance, as meeting the deductible threshold is required before the negotiated rate applies.
To avoid unexpected costs, consumers should request a prompt-pay discount if paying out-of-pocket, as hospitals often offer immediate fee reductions for upfront payments. Additionally, if you have insurance, ensure you receive an itemized bill rather than a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can inflate your total. If you encounter a balance bill from an out-of-network provider, you may be protected by the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Always dispute any surprise charges in writing and request a formal audit to ensure all services rendered are accurately coded and billed.