Office visit, established patient (20-29 min)
Facility: Smith County Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $108
- Cash Discount Price: $120
- vs. Medicare Baseline: 1.13x 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 - $67 | 40% |
| Medicaid / KanCare | $57 - $249 | 60% |
| Multiplan-All Plans | $74 - $216 | 78% |
| Wppa-All Plans | $77 - $226 | 81% |
| UnitedHealthcare | $78 - $228 | 82% |
| Midlands Choice-All Plans | $78 - $228 | 82% |
| Health Partners Of Ks Ppo-All Plans | $78 - $228 | 82% |
Consumer Guidance & Cost Commentary
For CPT code 99213, representing an office visit with an established patient lasting 20 to 29 minutes, Smith County Memorial Hospital in Smith Center, KS, lists a gross charge of $120.00. This amount is identical to the cash median and the Medicare benchmark of $95.19, with a ratio of 1.1 times the Medicare rate. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates for major payers like Blue Cross Blue Shield, Medicaid/KanCare, and UnitedHealthcare range from $38 to $249. These negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the full cash rate of $120.00 directly, provided they have the funds available.
To ensure you receive the most accurate pricing, it is important to distinguish between the hospital's gross charges and the actual amounts your insurance will pay. Although the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected ancillary services or out-of-network physicians could still trigger additional charges. Before scheduling, you should explicitly ask the hospital to classify your visit as "self-pay" to secure prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if you receive a summary bill, request a full itemized audit to verify that no unbundled codes or services not rendered have inflated your total, as over 80% of hospital bills contain errors that can be corrected through a formal written dispute.