Office visit, established patient (20-29 min)
Facility: William Newton Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $124
- Cash Discount Price: $261
- vs. Medicare Baseline: 1.30x 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 |
|---|---|---|
| Ambetter / Centene | $46 - $355 | 48% |
| Triwest- All Plans | $52 - $124 | 55% |
| Blue Cross Blue Shield | $55 - $128 | 58% |
| UnitedHealthcare | $59 - $319 | 62% |
| Providrs Care Nexus | $100 - $217 | 105% |
| Providrs Care - All Other Plans | $115 - $248 | 121% |
Consumer Guidance & Cost Commentary
For this office visit at William Newton Hospital in Winfield, Kansas, the cash price is $261.00, which matches the facility's cash median. While the hospital's negotiated rates for in-network plans range from $46 to $319 depending on the insurer, the cash price is notably lower than the negotiated amounts for most payers, including UnitedHealthcare and Blue Cross Blue Shield. This suggests that patients with high-deductible plans or those without insurance may save money by paying the cash price directly, as the insurance negotiated rates often exceed the cash rate. However, patients should verify their specific plan's deductible status before deciding, as paying the full cash price upfront may still result in out-of-pocket costs if the deductible has not been met.
To ensure you are not overcharged, it is important to distinguish between the hospital's gross charges and the actual amounts paid. The Medicare benchmark for this service is $95.19, which serves as a baseline for fair pricing; commercial rates are often higher due to administrative costs and contract dynamics. If you receive a bill that includes unexpected charges beyond the negotiated or cash rate, you may be facing balance billing, which is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act. Before finalizing payment, request a full itemized bill to review every code and service rendered, and ask the billing department about any available self-pay or prompt-pay discounts that could further reduce your cost.