Office visit, established patient (20-29 min)
Facility: Decatur Health
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $104
- Cash Discount Price: $147
- vs. Medicare Baseline: 1.09x 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 |
|---|---|---|
| Aetna | $46 - $247 | 48% |
| Medicaid / KanCare | $46 - $250 | 48% |
| Blue Cross Blue Shield | $49 - $172 | 51% |
| UnitedHealthcare | $50 - $133 | 53% |
| Wppa/Providrs Care- All Plans | $72 - $104 | 76% |
| Humana | $74 - $107 | 78% |
| Midlands Choice- All Plans | $80 - $157 | 84% |
Consumer Guidance & Cost Commentary
For this office visit at Decatur Health in Oberlin, Kansas, the cash price of $147.00 is notably lower than the facility's negotiated rates with major payers like Aetna, Medicaid/KanCare, and Blue Cross Blue Shield, which range from $46 to $250. While the cash price is higher than the facility's median negotiated rate of $104.00, it remains significantly below the gross chargemaster of $163.00. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. To maximize savings, it is advisable to contact the hospital directly to inquire about self-pay discounts or prompt-pay incentives, which can further reduce the final bill.
This service is benchmarked against the Medicare rate of $95.19, showing a markup of 1.1 times the federal standard. The facility, a voluntary non-profit Critical Access Hospital, serves the Oberlin area (ZIP 67749) and has no facility rating available in this dataset. Because commercial insurance contracts often include administrative overhead that inflates the baseline price by 20% to 40%, comparing rates to the Medicare benchmark provides a clearer picture of the true cost of care. Consumers should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, unexpected charges can still occur for out-of-network ancillary services like lab work or emergency physicians. If a surprise bill is received, patients should dispute it in writing with the insurer and request a No Surprises Act audit rather than paying immediately.