Office visit, established patient (20-29 min)
Facility: Stanton County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $207
- Cash Discount Price: $130
- vs. Medicare Baseline: 2.17x 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 217% of the Medicare baseline (a markup of 117%). 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 | $127 - $230 | 133% |
| Healthy Blue Mcaid | $207 | 217% |
| Healthy Blue Mcr Adv - All Other Plans | $238 | 250% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit with an established patient lasting 20 to 29 minutes, Stanton County Hospital in Johnson, KS, lists a cash price of $130.00. This cash rate is significantly lower than the facility's negotiated rates with major payers, which range from $127 to $238 depending on the specific Blue Cross Blue Shield plan or Healthy Blue Mcaid/Mcr Advantage plan. While the cash price is the lowest option listed, patients with high-deductible plans should consider that paying out-of-pocket might be more cost-effective if their insurance negotiated rate exceeds $130.00, as the patient would only be responsible for their deductible and coinsurance rather than the full negotiated amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available to further reduce the final cost.
When evaluating the value of this service, it is important to compare the facility's pricing against the Medicare benchmark, which serves as a scientifically validated baseline for healthcare costs. The Medicare amount for this procedure is $95.19, and the facility's cash rate of $130.00 represents a markup of 2.2 times the Medicare rate. This comparison helps identify the true cost of care rather than relying on inflated chargemaster lists. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized bill to verify that all charges are accurate and that no services were unbundled or double-billed before finalizing payment.