Office visit, established patient (20-29 min)
Facility: Lindsborg Community Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $139
- Cash Discount Price: $129
- vs. Medicare Baseline: 1.46x 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 |
|---|---|---|
| Tricare | $23 - $184 | 24% |
| Coventry Mcr Adv | $23 - $186 | 24% |
| Cigna | $42 - $333 | 44% |
| Coventry Comm-All Other Plans | $44 - $353 | 46% |
| UnitedHealthcare | $44 - $353 | 46% |
| Multiplan-All Plans | $46 - $365 | 48% |
| Phcs Preferred-All Plans | $46 - $365 | 48% |
| Coventry Wc | $47 - $372 | 49% |
| Century Health-All Plans | $47 - $372 | 49% |
| Wppa-All Plans | $47 - $372 | 49% |
| Health Partners -All Plans | $47 - $372 | 49% |
| Blue Cross Blue Shield | $67 | 70% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, the gross charge at Lindsborg Community Hospital is $185.00. This facility, a Critical Access Hospital in Lindsborg, KS, has negotiated rates ranging from $23 to $372 across 12 different payers, with the lowest allowed amount being $23.00 for Tricare and Coventry Mcr Adv. The cash price for this service is $129.00, which is notably lower than the median negotiated rate of $139.00 and the median paid amount of $137.00. When compared to the Medicare benchmark of $95.19, the cash price represents a 35% increase, while the median negotiated rate is 44% higher than the Medicare amount.
Patients should be aware that while in-network insurance often caps costs at the negotiated rate, paying cash upfront can sometimes result in a lower out-of-pocket expense if the insurance allowed amount exceeds the cash price. For this specific service, the cash rate of $129.00 is lower than the median negotiated rate of $139.00, suggesting that cash payment may be more cost-effective for those without insurance or with high-deductible plans. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by bypassing administrative processing fees and claim denials. It is important to request these discounts before scheduling and to ensure a waiver of insurance submission is signed to prevent automatic claims that could void the cash agreement.