Office visit, established patient (20-29 min)
Facility: Fredonia Regional Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $135
- Cash Discount Price: $169
- vs. Medicare Baseline: 1.42x 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 | $37 - $238 | 39% |
| UnitedHealthcare | $66 - $238 | 69% |
| Meritain-All Plans | $66 - $238 | 69% |
| Reserve National-All Plans | $66 - $238 | 69% |
| Cigna | $66 - $238 | 69% |
| Blue Cross Blue Shield | $131 - $152 | 138% |
| Veterans Programs - All Plans | $135 - $152 | 142% |
Consumer Guidance & Cost Commentary
For this office visit at Fredonia Regional Hospital in Kansas, the cash price is $169.00, which matches the median cash rate for this service in the state. While the facility is a Critical Access Hospital with government local ownership, the negotiated rates for major payers like Aetna, UnitedHealthcare, and Cigna range from $66 to $238, significantly higher than the cash price. This disparity highlights a common billing scenario where paying out-of-pocket upfront can be more cost-effective than relying on insurance, especially for patients with high deductibles. Since the median negotiated rate is $135.00 and the cash price is $169.00, patients with high-deductible plans may save money by paying the cash price directly, provided they secure a prompt-pay discount before the claim is submitted.
To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount prior to scheduling or check-in, as billing systems often default to insurance processing once a card is on file. It is important to note that while the Medicare benchmark for this service is $95.19, commercial rates often exceed this baseline due to administrative costs and contract dynamics; however, the cash price here is higher than the Medicare amount, so the primary benefit of cash payment lies in avoiding the full negotiated insurance rate rather than beating the Medicare benchmark. Consumers should also be aware of the No Surprises Act protections against balance billing for out-of-network services at in-network facilities, ensuring that any additional charges are transparent and legally compliant.