Office visit, established patient (20-29 min)
Facility: Cloud County Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $117
- Cash Discount Price: $88
- vs. Medicare Baseline: 1.23x 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 |
|---|---|---|
| Mpi-All Plans | $71 - $201 | 75% |
| Aetna | $81 - $197 | 85% |
| Pponext-All Plans | $84 - $201 | 88% |
| Health Partners - All Plans | $86 - $201 | 90% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient at Cloud County Health Center in Concordia, KS, the cash median price is $88.00, which is lower than the facility's negotiated rate of $117.00. While the facility is a Critical Access Hospital in Kansas, the data provided does not include specific state or county average benchmarks for comparison. However, it is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Patients should always verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront incentives can significantly reduce out-of-pocket costs.
The Medicare benchmark for this service is $95.19, which serves as a scientifically validated baseline for the true cost of care. The facility's cash rate of $88.00 is below the Medicare amount, while the median paid amount of $120.00 reflects the average reimbursement across payers. When reviewing your bill, ensure you receive an itemized statement rather than a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a large bill, dispute any errors in writing to the billing supervisor rather than accepting verbal assurances, and remember that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities.