Office visit, established patient (20-29 min)
Facility: Wilson Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $166
- Cash Discount Price: $135
- vs. Medicare Baseline: 1.74x 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 | $38 - $360 | 40% |
| Ambetter / Centene | $46 - $360 | 48% |
| Aetna | $46 - $360 | 48% |
| UnitedHealthcare | $46 - $335 | 48% |
| Cigna | $60 - $288 | 63% |
| Tricare | $60 - $194 | 63% |
| Health Partners-All Plans | $69 - $331 | 72% |
| Mulitplan-All Plans | $69 - $331 | 72% |
| Humana | $135 - $194 | 142% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Wilson Medical Center in Neodesha, KS, lists a gross charge of $180.00. While the facility's cash median rate is $135.00, which is lower than the state average, patients should be aware that insurance negotiated rates can sometimes exceed this cash price. For instance, Blue Cross Blue Shield has a negotiated range of $38 to $360, and Aetna ranges from $46 to $360, meaning a patient with a high-deductible plan might find paying the $135.00 cash rate directly more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if their deductible is not yet met.
It is important to distinguish between the facility's gross charges and the actual amounts paid by insurers. The median amount paid by payers is $163.00, while the median negotiated rate across all plans is $166.00. These figures are significantly higher than the Medicare benchmark of $95.19, illustrating that commercial rates often include administrative overhead and markup beyond the true cost of care. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, and request a full itemized bill to ensure no errors or unbundled charges are included before finalizing payment.