Office visit, established patient (20-29 min)
Facility: Clay County Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $70
- Cash Discount Price: $105
- vs. Medicare Baseline: 0.74x 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 | $29 - $128 | 30% |
| Multiplan- All Plans | $29 - $130 | 30% |
| Wppa/Providrs Care- All Plans | $29 - $128 | 30% |
| UnitedHealthcare | $29 - $130 | 30% |
| Health Partners - All Plans | $29 - $130 | 30% |
Consumer Guidance & Cost Commentary
This office visit at Clay County Medical Center in Clay Center, KS, has a gross charge of $105.00, which matches the facility's cash median rate. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates for major payers like Aetna and UnitedHealthcare range from $29 to $130, which is notably higher than the cash price. For patients with high-deductible plans, paying the $105 cash rate directly could be more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash price due to administrative markups. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket may result in immediate savings compared to the negotiated rates your insurer would apply.
The Medicare benchmark for this service is $95.19, which serves as a reliable baseline for evaluating pricing fairness. Although the facility's cash rate is slightly above the Medicare amount, the negotiated rates for commercial payers can vary significantly, with some plans potentially paying up to $130. To minimize costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Additionally, if you receive a bill from an out-of-network provider at this in-network facility, you may be entitled to protections under the No Surprises Act, which prevents balance billing for emergency or non-emergency services. Always request an itemized bill to ensure no unbundled codes or services not rendered are included before finalizing payment.