Office visit, established patient (20-29 min)
Facility: Hodgeman County Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $176
- Cash Discount Price: $200
- vs. Medicare Baseline: 1.85x 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 | $127 - $133 | 133% |
| Humana | $160 | 168% |
| Triwest - All Plans | $160 | 168% |
| Medicaid / KanCare | $160 - $250 | 168% |
| UnitedHealthcare | $160 - $238 | 168% |
| Aetna | $200 | 210% |
| First Health - All Plans | $225 | 236% |
| Wppa (Provdrscare) - All Plans | $238 | 250% |
| Health Partners - All Plans | $238 | 250% |
Consumer Guidance & Cost Commentary
For this office visit at Hodgeman County Health Center in Jetmore, Kansas, the negotiated rates range from $127 to $250, with a median negotiated amount of $176.00. This facility is a Critical Access Hospital owned by the local government, and its pricing structure is significantly higher than the state average. While the cash price is listed at $200.00, which is lower than the median negotiated rate of $176.00, patients with high-deductible plans should verify if paying cash upfront could save money compared to their insurance allowed amount. It is important to note that commercial insurance rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to the true cost of care.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, unexpected ancillary services or out-of-network providers could still trigger additional charges. To avoid these surprises, always request a full itemized CPT-coded bill before paying, as summary bills often obscure individual line items and code unbundling errors. Additionally, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid in full within a short window, bypassing the costly claims processing cycle.