Office visit, established patient (20-29 min)
Facility: Morris County Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $121
- Cash Discount Price: $133
- vs. Medicare Baseline: 1.27x 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 | $36 - $133 | 38% |
| Choice Care Mcr Adv-All Plans | $58 - $115 | 61% |
| UnitedHealthcare | $58 - $294 | 61% |
| Coventry Mcr | $58 - $115 | 61% |
| Va Ccn-All Plans | $58 - $115 | 61% |
| Cigna | $109 - $213 | 115% |
| Aetna | $134 - $263 | 141% |
| Multiplan-All Plans | $135 - $265 | 142% |
| Coventry Comm-All Other Plans | $135 - $265 | 142% |
| Providrs Care (Wppa)(Nexus)-All Plans | $225 - $441 | 236% |
Consumer Guidance & Cost Commentary
For this office visit at Morris County Hospital in Council Grove, KS, the cash price of $133 is notably lower than the facility's gross charge of $222, reflecting a significant discount for self-pay patients. While the facility is a Critical Access Hospital with government local ownership, the cash rate aligns closely with the state average, offering a predictable cost for those without insurance. However, patients with high-deductible plans should consider that paying cash upfront might be more economical than using insurance, as the negotiated rates for in-network payers like UnitedHealthcare and Aetna range from $58 to $294, which often exceed the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these programs can further reduce the final bill by bypassing administrative fees and claims processing costs.
When comparing this service to Medicare, the cash price of $133 represents a markup of 1.3 times the Medicare benchmark of $95.19, which serves as the objective baseline for evaluating hospital pricing. Although commercial negotiated rates are typically higher than Medicare due to administrative overhead and contract dynamics, the facility's cash rate remains competitive within the region. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under federal law, but it is crucial to verify network status before scheduling to avoid unexpected charges. If you receive a bill, request a full itemized statement to review every line item for potential errors, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.