Office visit, established patient (20-29 min)
Facility: St Luke Hospital & Living Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $62
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.65x 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 |
|---|---|---|
| UnitedHealthcare | $28 - $197 | 29% |
| Humana | $28 - $197 | 29% |
| Bluestem Pace | $28 - $197 | 29% |
| Ambetter / Centene | $28 - $199 | 29% |
| Blue Cross Blue Shield | $28 - $197 | 29% |
| Va Ccn | $28 - $197 | 29% |
| Kansas Department Of Health And Environment | $28 - $197 | 29% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit with an established patient lasting 20 to 29 minutes, St Luke Hospital & Living Center in Marion, KS, lists a gross charge of $122.00. This amount is significantly higher than the state average, which is 70% of the facility's gross rate. While the facility is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates for in-network payers such as UnitedHealthcare and Humana range from $28 to $199, depending on the specific plan. It is important to note that cash-pay options are not listed for this service, so patients relying on high-deductible plans should verify if paying out-of-pocket could result in lower costs compared to their insurance negotiated rate, though the data indicates no cash median is available.
Patients should be aware that commercial insurance contracts often include administrative overhead that inflates the baseline price, and the facility's negotiated rates reflect these contractual dynamics. If you have a balance bill or receive a summary bill, you should request a full itemized audit to identify unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Additionally, since this is a government-owned facility, you may be eligible for prompt-pay discounts if you choose to settle the bill upfront, though specific discount percentages are not provided in the current data. Always confirm your deductible status before scheduling, as paying the full negotiated rate without meeting your deductible can lead to unexpected financial exposure.