Office visit, established patient (20-29 min)
Facility: Lincoln County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $133
- Cash Discount Price: $91
- vs. Medicare Baseline: 1.40x 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 | $133 | 140% |
Consumer Guidance & Cost Commentary
For this office visit at Lincoln County Hospital in Lincoln, KS, the cash price of $91.00 is notably lower than the facility's negotiated rate of $133.00 for Blue Cross Blue Shield, which is the only payer listed for this service. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans might find paying the cash price directly more cost-effective if their insurance negotiated rate exceeds this amount. It is important to note that the cash price is also lower than the Medicare benchmark of $95.19, suggesting that the facility's pricing structure for this specific CPT code is competitive relative to federal reimbursement standards.
To ensure you are not overcharged, always request a prompt-pay discount before scheduling your appointment, as these upfront payment incentives can significantly reduce the final bill. If you do receive a bill after insurance processing, do not accept a summary invoice; instead, demand a full itemized audit to verify that no services were unbundled or double-charged. Be aware that balance billing is generally prohibited for out-of-network care at in-network facilities under the No Surprises Act, so if you encounter unexpected charges, you have the right to dispute them with your insurer or request a formal audit rather than paying immediately out of fear.