Office visit, established patient (20-29 min)
Facility: Girard Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $157
- Cash Discount Price: $92
- vs. Medicare Baseline: 1.65x 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 | $38 - $247 | 40% |
| Humana | $42 - $247 | 44% |
| Ambetter / Centene | $42 - $247 | 44% |
| UnitedHealthcare | $42 - $426 | 44% |
| Kansas Superior Select-All Plans | $42 - $247 | 44% |
| Medicare (plans) | $42 - $247 | 44% |
| Aetna | $42 - $784 | 44% |
| Multiplan-All Plans | $74 - $414 | 78% |
| Uhhis-All Plans | $80 - $426 | 84% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Girard Medical Center in Girard, KS, lists a cash median price of $92.00 and a median negotiated rate of $157.00. While the facility's cash price is notably lower than its negotiated rates, it is important to note that for patients with high-deductible plans, paying cash may not always be the most economical option if the insurance negotiated rate exceeds the cash price. The facility, a Critical Access Hospital owned by a Government Hospital District, has a facility rating of 2. Patients are encouraged to verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront payment incentives can significantly reduce the final amount owed.
The pricing data for this service reflects a range across nine different payers, with negotiated amounts varying from $38 to $784 depending on the specific insurance plan. For instance, Blue Cross Blue Shield plans range from $38 to $247, while Aetna plans can range up to $784. It is crucial to understand that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price compared to the Medicare benchmark. In this case, the Medicare amount is $95.19, which serves as a scientifically validated cost baseline; commercial rates typically average between 200% and 300% of this figure, whereas fair pricing is generally defined as 120% to 150%. Consumers should avoid comparing discounts against the hospital's inflated chargemaster list and instead focus on the Medicare