Office visit, established patient (20-29 min)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $79
- Cash Discount Price: $85
- vs. Medicare Baseline: 0.83x 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 |
|---|---|---|
| Humana | $37 - $74 | 39% |
| Tricare | $40 - $79 | 42% |
| UnitedHealthcare | $46 - $264 | 48% |
| Medicaid / KanCare | $46 - $264 | 48% |
| Healthy Blue Mcaid - All Plans | $46 - $150 | 48% |
| Blue Cross Blue Shield | $52 - $183 | 55% |
| Va Ccn - All Plans | $55 - $93 | 58% |
| Ambetter / Centene | $58 - $264 | 61% |
| Aetna | $68 - $135 | 71% |
| Health Partners - All Plans | $71 - $142 | 75% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient (20-29 minutes), the facility's cash median rate is $85.00, while the median negotiated rate for insured patients is $79.00. This specific service is billed at a gross amount of $100.00. It is important to note that for patients with high-deductible plans, paying the cash price of $85.00 upfront may be more cost-effective than relying on insurance, as the negotiated rate of $79.00 often exceeds the cash price due to administrative overheads included in commercial contracts. Additionally, this facility, a Critical Access Hospital in Wakeeney, KS, is owned by the local government, which may influence pricing structures compared to private entities.
When evaluating the value of this service, it is crucial to compare rates against the broader market rather than the facility's inflated chargemaster list. The data indicates that while specific payer plans have varying negotiated ranges, the facility's cash rate is a key benchmark for self-pay patients. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected ancillary services could still trigger additional charges. To ensure the lowest possible cost, consumers are advised to request a "self-pay" or "prompt-pay" discount before scheduling, as paying in full upfront can often bypass the administrative costs associated with insurance claims processing.