Office visit, established patient (20-29 min)
Facility: Golden Valley Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $67
- Cash Discount Price: $75
- vs. Medicare Baseline: 0.70x 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 |
|---|---|---|
| Aetna | $61 | 64% |
| Humana | $61 | 64% |
| UnitedHealthcare | $61 - $2,910 | 64% |
| Ambetter / Centene | $73 | 77% |
| Home State Health | $3,080 | 3236% |
Consumer Guidance & Cost Commentary
Golden Valley Memorial Hospital in Clinton, Missouri, reports a cash median price of $75 for CPT code 99213, an office visit for an established patient lasting 20 to 29 minutes. While the facility's gross charge is listed at $125 and the Medicare benchmark rate is $95.19, the median negotiated rate for commercial payers is $67. It is important to note that the median paid amount is not available in the current data. Patients should be aware that cash-pay options can sometimes be more cost-effective than standard insurance billing, particularly if a patient's plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. Additionally, asking the hospital about self-pay or prompt-pay discounts before scheduling can often result in further reductions to the final bill.
The pricing data reflects a vintage from June 2026 and includes information from five payers, with UnitedHealthcare and Home State Health showing significantly higher rate spreads compared to Aetna, Humana, and Ambetter/Centene. Under the Medicare benchmarking principle, the commercial negotiated rate of $67 represents a markup relative to the federal baseline of $95.19, illustrating that commercial rates can vary widely based on contract terms. While the data does not provide specific state or county average comparisons for this code, the facility operates as a government-owned acute care hospital in Clinton, Missouri. Consumers are advised to request an itemized billing audit if they receive a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Furthermore, under the No Surprises Act, patients are protected from balance billing for out