Office visit, established patient (20-29 min)
Facility: Greenwood County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $179
- Cash Discount Price: $220
- vs. Medicare Baseline: 1.88x 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 - $67 | 38% |
| Triwest - All Plans | $75 - $121 | 79% |
| Tricare | $89 - $143 | 93% |
| Choicecare Mcr Adv - All Plans | $89 - $143 | 93% |
| UnitedHealthcare | $89 - $286 | 93% |
| Integrated Health Plan - All Plans | $158 - $255 | 166% |
| First Health Ccn Network | $179 - $289 | 188% |
| Beech Street - All Plans | $179 - $289 | 188% |
| First Health - All Other Plans | $179 - $289 | 188% |
| Preferred Hs (Coventry) - All Plans | $190 - $306 | 200% |
| Principal Health Care Inc - All Plans | $200 - $323 | 210% |
| Medicaid / KanCare | $211 - $340 | 222% |
| Amerigroup Mcaid-All Plans | $211 - $340 | 222% |
| Providrs Care/Wppa - All Plans | $316 - $510 | 332% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, the facility's cash median rate is $220.00, while the median negotiated rate paid by insurance plans is $179.00. This indicates that for many patients with high-deductible plans, paying cash upfront could be more cost-effective than relying on insurance, as the negotiated rates exceed the cash price. It is important to note that while the facility is a Critical Access Hospital in Eureka, KS, the specific county or state average data is not provided in this report, so patients should verify local pricing benchmarks directly with the hospital or their insurer.
The data shows a significant range in allowed amounts across different payers, with Blue Cross Blue Shield offering the lowest range at $36 to $67 and Medicaid/KanCare ranging from $211 to $340. Because this is a Critical Access Hospital, patients should proactively ask about "self-pay" or "prompt-pay" discounts before scheduling, as these can reduce the final bill by 20% to 50%. If you receive a bill that includes charges for services not rendered or items that were cancelled, you have the right to request a formal itemized billing audit to identify errors, as over 80% of hospital bills contain mistakes. Always dispute any balance billing or unexpected charges in writing rather than accepting summary bills or verbal assurances, and remember that the No Surprises Act protects you from being balance-billed for out-of-network services at in-network facilities.