Office visit, established patient (20-29 min)
Facility: Children'S Mercy South
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $126
- Cash Discount Price: $109
- vs. Medicare Baseline: 1.32x 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 |
|---|---|---|
| UnitedHealthcare | $48 - $196 | 50% |
| Healthy Blue | $51 - $94 | 54% |
| Medicaid / KanCare | $52 - $131 | 55% |
| Healthlink | $62 - $256 | 65% |
| Quiktrip | $62 - $189 | 65% |
| Blue Cross Blue Shield | $64 - $215 | 67% |
| Multiplan | $77 - $221 | 81% |
| Aetna | $79 - $198 | 83% |
| Wppa Providrs Care | $86 - $189 | 90% |
| Health Midwest Comprehensive Care | $89 - $189 | 93% |
| Humana | $92 - $194 | 97% |
| Orscheln | $93 - $189 | 98% |
| American Healthcare Alliance | $93 - $247 | 98% |
| Home State Health | $94 | 99% |
| Cigna | $95 - $250 | 100% |
| Nebraska Furniture Mart | $96 - $189 | 101% |
| Medica | $96 - $170 | 101% |
| Coventry Health Care Of Kansas | $100 - $215 | 105% |
| Mercy Health | $120 - $218 | 126% |
| Coxhealth Network | $122 - $215 | 128% |
| Wellfit/Centrus | $123 - $189 | 129% |
| Centivo | $126 - $189 | 132% |
| National Preferred Provider Network | $145 - $262 | 152% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit with an established patient lasting 20 to 29 minutes, Children's Mercy South in Overland Park, KS, lists a gross charge of $228.00. While the facility offers a cash median price of $109.00, commercial insurance negotiated rates vary significantly across 23 payers, ranging from a low of $48.00 with UnitedHealthcare to a high of $262.00 with the National Preferred Provider Network. When compared to the Medicare benchmark of $95.19, the facility's cash rate is 114% of the Medicare amount, indicating a markup that is lower than the typical 200% to 300% range often seen in commercial pricing. However, patients should be aware that many in-network plans will pay negotiated rates that exceed this cash price, potentially resulting in higher out-of-pocket costs if the patient has not yet met their deductible.
To optimize costs, patients should verify their specific plan's allowed amount before scheduling, as some insurers may pay significantly more than the cash rate. It is also important to inquire directly with the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the cash price by 20% to 50% for upfront payment. Additionally, if a patient receives an itemized bill, they should request a full line-by-line audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies. By comparing the facility's rates against the Medicare baseline and actively seeking out cash discounts or audit opportunities,