Office visit, established patient (20-29 min)
Facility: Minneola District Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $171
- Cash Discount Price: $126
- vs. Medicare Baseline: 1.80x 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 | $38 - $133 | 40% |
| Corporate Plan Management-All Plans | $106 - $255 | 111% |
| Providrs Care Network-All Plans | $106 - $255 | 111% |
| Preferred Health Care (Coventry)-All Other Plans | $112 - $270 | 118% |
| Triwest-All Plans | $112 - $270 | 118% |
| Aetna | $119 - $300 | 125% |
| UnitedHealthcare | $119 - $391 | 125% |
| Phc (Coventry) Leased Network | $119 - $285 | 125% |
| Health Partners Of Kansas-All Plans | $119 - $285 | 125% |
| Va Community Care Program-All Plans | $121 - $391 | 127% |
| Humana | $121 - $391 | 127% |
| Medicaid / KanCare | $125 - $300 | 131% |
Consumer Guidance & Cost Commentary
For this office visit at Minneola District Hospital, the cash price is $126.00, which is lower than the facility's gross charge of $180.00. While the median negotiated rate across 12 payers is $171.00, patients with high-deductible plans might find paying cash directly more cost-effective if their insurance allowed amount exceeds the cash price. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the Medicare benchmark of $95.19, which serves as a scientifically validated baseline for the true cost of care.
To avoid unexpected costs, patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary widely among the 12 participating payers, ranging from $38 to $391. If you are self-pay, ask the hospital about "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, bypassing the administrative fees associated with insurance claims. Additionally, if you receive a summary bill, request a full itemized audit to ensure no errors, unbundled codes, or services not rendered are included, as over 80% of hospital bills contain discrepancies that can be resolved through a formal written dispute.