Office visit, established patient (20-29 min)
Facility: Sheridan County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $109
- Cash Discount Price: $143
- vs. Medicare Baseline: 1.15x 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 |
|---|---|---|
| Celtic Insurance | $43 - $162 | 45% |
| Blue Cross Blue Shield | $53 - $149 | 56% |
| UnitedHealthcare | $67 - $254 | 70% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Sheridan County Hospital in Hoxie, KS, lists a cash price of $143.00. This cash rate is identical to the facility's median negotiated rate of $109.00, which is notably lower than the highest negotiated rate of $254.00 observed among UnitedHealthcare plans. When compared to the Medicare benchmark of $95.19, the cash price represents a 1.1x markup, indicating the cost relative to the federal government's baseline reimbursement. While commercial negotiated rates often average 200% to 300% of Medicare, this specific service shows a more moderate increase, suggesting potential value depending on your specific insurance plan's allowed amount.
Patients should be aware that cash-paying may sometimes be more cost-effective than using insurance, particularly if your plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. Although the facility is a Critical Access Hospital owned by the local government, it is important to verify your specific plan's allowed amount before scheduling, as in-network rates can vary significantly between payers. We recommend contacting the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if you settle the account upfront. Additionally, if you are concerned about potential balance billing or errors, always request a full itemized bill before making any payments to ensure all charges are accurate and compliant with federal protections.