Office visit, established patient (20-29 min)
Facility: Phillips County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $140
- Cash Discount Price: $121
- vs. Medicare Baseline: 1.47x 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 - $242 | 40% |
| UnitedHealthcare | $92 - $155 | 97% |
| Medicaid / KanCare | $115 - $155 | 121% |
| Health Partners-All Plans | $115 - $155 | 121% |
Consumer Guidance & Cost Commentary
This office visit for an established patient at Phillips County Hospital in Phillipsburg, Kansas, has a gross charge of $143.00, which is significantly higher than the facility's cash median of $121.00 and the state average of $115.00. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. For instance, UnitedHealthcare and Medicaid/KanCare have negotiated rates ranging from $92.00 to $155.00, which can be more expensive than paying cash directly. If you have a high-deductible plan, paying the cash price of $121.00 upfront might result in lower out-of-pocket costs compared to your insurance allowing a higher negotiated amount, provided you can afford the immediate payment.
To ensure you are not overcharged, it is crucial to request a detailed, itemized bill before paying, as summary bills often hide errors or unbundled charges that inflate the total. Since over 80% of hospital bills contain errors, asking for a line-by-line review can help identify services not rendered or codes that should be bundled. Additionally, if you receive a balance bill for out-of-network services, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Finally, do not assume that being in-network guarantees the lowest price; always verify your specific plan's allowed amount and ask the hospital about prompt-pay discounts, which can reduce the final balance by 20% to 50% if paid in full