Office visit, established patient (20-29 min)
Facility: Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $191
- Cash Discount Price: $149
- vs. Medicare Baseline: 2.01x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Tricare | $48 - $274 | 50% |
| Humana | $48 - $274 | 50% |
| Medicare (plans) | $49 - $276 | 51% |
| Ambetter / Centene | $53 - $301 | 56% |
| Coventry - All Other Plans | $87 - $493 | 91% |
| Health Partners Of Kansas - All Plans | $91 - $520 | 96% |
| Preferred Healthcare-All Plans | $91 - $520 | 96% |
| Wppa/Providers Care-All Plans | $135 - $766 | 142% |
| Blue Cross Blue Shield | $141 | 148% |
Consumer Guidance & Cost Commentary
For this office visit at Memorial Hospital in Abilene, KS, the cash price of $149.00 is the lowest amount a patient can pay upfront. While insurance plans like Tricare and Humana negotiate rates as high as $274, paying cash directly often results in a lower total cost, especially for those with high-deductible plans. The facility offers a prompt-pay discount, which can reduce the bill by 20% to 50% if paid in full within 30 days, effectively bringing the cost closer to the cash price. To secure this discount, patients should request a self-pay classification and sign a waiver of insurance submission before check-in to prevent automatic claims processing that would void the cash agreement.
The negotiated rates for this service range from $48 to $520 across nine different payers, with the highest allowed amount reaching $766 for Wppa/Providers Care. This variation highlights that in-network coverage does not guarantee the lowest price, as some commercial contracts exceed the cash rate. Additionally, the facility's cash price of $149.00 is significantly higher than the Medicare benchmark of $95.19, indicating a markup of 200% over the federal baseline. Patients should review their itemized bill to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.