Office visit, established patient (20-29 min)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $80
- Cash Discount Price: $180
- vs. Medicare Baseline: 0.84x 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 |
|---|---|---|
| Aetna | $55 - $144 | 58% |
| UnitedHealthcare | $63 - $265 | 66% |
| Blue Cross Blue Shield | $77 - $133 | 81% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash price of $180.00, which matches the facility's median negotiated rate of $80.00 and the cash median. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data indicates a significant gap between what commercial payers are willing to pay and the cash price. For instance, UnitedHealthcare's negotiated range spans from $63 to $265, and Blue Cross Blue Shield's range is $77 to $133, both of which exceed the $180.00 cash price. This suggests that for patients with high-deductible plans, paying cash directly may result in a lower out-of-pocket cost compared to using insurance, as the insurance negotiated rates can sometimes be higher than the cash price.
To ensure you are receiving the most accurate pricing, it is important to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should verify if the facility offers a prompt-pay discount, which could further reduce the $180.00 cash price by bypassing administrative claim processing costs. When evaluating the facility's pricing against broader benchmarks, note that the Medicare amount for this service is $95.19, serving as a scientifically validated baseline for the true cost of care. While the facility's rating is 4 out of 5, the primary focus for consumers should remain on comparing the $180.00 cash price against