Office visit, established patient (20-29 min)
Facility: Osborne County Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $229
- Cash Discount Price: $233
- vs. Medicare Baseline: 2.41x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 241% of the Medicare baseline (a markup of 141%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $98 - $304 | 103% |
| Health Partners Of Kansas | $111 - $344 | 117% |
| Wppa | $123 - $380 | 129% |
| Blue Cross Blue Shield | $126 - $392 | 132% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, the facility's cash price of $233.00 is notably lower than the gross chargemaster rate of $273.00. While the negotiated rates for in-network payers like UnitedHealthcare and Blue Cross Blue Shield range from $98 to $392, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $233.00. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the cash price due to multi-layered contract dynamics.
This facility, a Critical Access Hospital in Osborne County, KS, operates under government-local ownership. The cash median of $233.00 is lower than the state average for this service, though specific county average data was not provided in the report. If you are paying out-of-network or receiving care from an out-of-network provider at this in-network facility, you may be subject to balance billing, where the provider bills you for the difference between the full chargemaster rate and what your insurance pays. To avoid unexpected costs, always request a self-pay or prompt-pay discount before scheduling, as these upfront payments can bypass costly insurance billing cycles and administrative fees. Additionally, if you receive an itemized bill, review it carefully for errors or unbundled codes, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.