Office visit, established patient (20-29 min)
Facility: Republic County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $89
- Cash Discount Price: $75
- vs. Medicare Baseline: 0.93x 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 |
|---|---|---|
| Rural Carriers-All Plans | $55 - $119 | 58% |
| Meritain-All Plans | $58 - $126 | 61% |
| Aetna | $58 - $126 | 61% |
| UnitedHealthcare | $60 - $129 | 63% |
| Midlands Choice-All Plans | $62 - $133 | 65% |
| First Health-All Plans | $62 - $133 | 65% |
| Cigna | $62 - $133 | 65% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, the facility's cash median rate is $75.00, which is lower than the negotiated rates paid by major insurers like Aetna, UnitedHealthcare, and Cigna, ranging from $58 to $133. While the facility's cash price is notably lower than the state average for this service, patients with high-deductible plans may find paying out-of-pocket at $75.00 more cost-effective than relying on insurance, which could result in a negotiated payment of up to $133.00 depending on the specific carrier. It is important to note that commercial insurance rates often include administrative overhead and contract markups that do not apply to direct cash payments, making the self-pay option a potentially significant savings for those who can afford it upfront.
To ensure you are not overcharged, we recommend requesting a prompt-pay discount if you choose to pay in full, as facilities often offer additional reductions for immediate payment. Furthermore, if you have insurance, always verify your deductible status before scheduling, as paying the negotiated rate may not be covered until that threshold is met. If you encounter a balance bill after receiving care, remember that the No Surprises Act protects you from being billed for out-of-network services at in-network facilities, and you should dispute any unexpected charges in writing rather than accepting summary bills or verbal assurances. Always ask the billing department for a full itemized statement before finalizing any payment to ensure all services rendered are accurately reflected.