Office visit, established patient (20-29 min)
Facility: Goodland Regional Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $99
- Cash Discount Price: $99
- vs. Medicare Baseline: 1.04x 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 |
|---|---|---|
| Wppa | $84 - $126 | 88% |
| UnitedHealthcare | $89 - $126 | 93% |
| Blue Cross Blue Shield | $133 | 140% |
Consumer Guidance & Cost Commentary
For this office visit with an established patient lasting 20 to 29 minutes, the facility's cash median price is $99.00, which is slightly lower than the negotiated rates typically paid by insurance carriers. While the gross charge is $110.00, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as commercial negotiated rates often include administrative overhead that inflates the baseline price. It is important to note that the facility is a Critical Access Hospital in Goodland, Kansas, and while specific state or county average data was not provided in this report, patients should always verify the facility's self-pay or prompt-pay discounts before scheduling to ensure they are receiving the lowest possible rate.
The data indicates that the facility's pricing is benchmarked against Medicare, with a Medicare amount of $95.19 and a ratio of 1.0 to the gross charge, suggesting the facility's rates are aligned with federal cost standards rather than inflated chargemaster lists. Three payers were represented in the dataset, with negotiated rates ranging from $84 to $133 depending on the insurance plan, highlighting that in-network status does not guarantee the lowest price. To avoid unexpected costs, patients are encouraged to request a formal itemized billing audit if they receive a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through written dispute to the billing supervisor.