Office visit, established patient (20-29 min)
Facility: Scott County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $131
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.38x 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 |
|---|---|---|
| UnitedHealthcare | $55 - $194 | 58% |
| Humana | $58 - $86 | 61% |
| Wppa | $83 - $1,200 | 87% |
| Aetna | $124 - $184 | 130% |
| Blue Cross Blue Shield | $133 | 140% |
Consumer Guidance & Cost Commentary
For this established patient office visit at Scott County Hospital in Scott City, KS, the negotiated rates range from $55 to $1,200 depending on your specific insurance plan, with UnitedHealthcare offering the lowest range at $55–$194 and WPPA the highest at $83–$1,200. While the facility's median negotiated rate of $131 is higher than the Medicare benchmark of $95.19, indicating a markup typical of commercial contracts, patients with high-deductible plans may find the cash price more advantageous. Although the cash median is not currently listed, understanding that cash-pay can sometimes be cheaper than insurance negotiated rates is crucial for those who have not yet met their deductible or whose plan allows for out-of-network cash discounts.
To ensure you are not overcharged, it is essential to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that should be consolidated. Additionally, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the total bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. Since this facility is a Critical Access Hospital with a voluntary non-profit ownership structure, verifying the exact allowed amount with the billing department prior to scheduling your visit will help prevent unexpected balance billing and ensure you are aware of your specific financial responsibility.