Office visit, established patient (20-29 min)
Facility: Amberwell Atchison Association
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $140
- Cash Discount Price: $259
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Va Ccn - All Plans | $57 - $101 | 60% |
| Superior Select Mcr Adv - All Plans | $57 - $224 | 60% |
| Triwest - All Plans | $57 - $101 | 60% |
| UnitedHealthcare | $57 - $547 | 60% |
| Humana | $57 - $1,551 | 60% |
| Ambetter / Centene | $88 - $156 | 92% |
| Cigna | $95 - $168 | 100% |
| Aetna | $95 - $168 | 100% |
| Blue Cross Blue Shield | $127 - $133 | 133% |
| Centrus Health Direct - All Plans | $129 - $229 | 136% |
| Oscar - All Plans | $129 - $229 | 136% |
| Multiplan - All Plans | $134 - $238 | 141% |
| Wppa Providrs Care - All Plans | $155 - $274 | 163% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit with an established patient lasting 20 to 29 minutes, Amberwell Atchison Association in Atchison, KS, lists a cash price of $259.00. This cash rate is significantly higher than the Medicare benchmark of $95.19, which serves as the federal baseline for evaluating hospital pricing markups. While the facility's cash price exceeds the state average for this service, it is important to note that for patients with high-deductible plans, paying the cash price directly can sometimes be more cost-effective than using insurance if the insurer's negotiated rate exceeds the cash amount. In this case, the median negotiated rate across payers is $140.00, which is lower than the cash price, suggesting that using an in-network plan may result in lower out-of-pocket costs once deductibles and copays are applied.
Patients should verify their specific plan details before scheduling, as commercial insurance contracts vary widely; for instance, Humana has a high-end negotiated rate of $1,551, while Blue Cross Blue Shield's range is $127 to $133. To minimize costs, individuals should ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total bill by 20% to 50% when paid upfront, bypassing the administrative overhead of insurance claims. Additionally, if a patient receives a bill after using insurance, they should request a full itemized audit to identify any errors, such as unbundled codes or services not rendered, as over 80% of hospital bills contain inaccuracies that can be corrected to