Office visit, established patient (20-29 min)
Facility: Wheatland Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $281
- Cash Discount Price: $301
- vs. Medicare Baseline: 2.95x 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 295% of the Medicare baseline (a markup of 195%). 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 |
|---|---|---|
| Healthnet Federal-All Plans | $57 - $514 | 60% |
| Triwest-All Plans | $57 - $514 | 60% |
| UnitedHealthcare | $63 - $538 | 66% |
| Blue Cross Blue Shield | $76 | 80% |
| Allegiance Provider-All Plans | $78 - $467 | 82% |
| First Choice Big Sky-All Plans | $78 - $522 | 82% |
| Community Health Ntwk-All Plans | $85 - $522 | 89% |
| Interwest Ppo-All Plans | $85 - $522 | 89% |
| City Of Billings-All Plans | $86 - $824 | 90% |
| Mountain Health Co-Op-All Plans | $86 - $522 | 90% |
| Rocky Mountain Health Network-All Plans | $86 - $522 | 90% |
| Pacific Source-All Other Plans | $87 - $522 | 91% |
| Pacific Steel & Recycling-All Plans | $88 - $522 | 92% |
| Naphcare-All Plans | $92 | 97% |
| Ccn-All Plans | $98 - $533 | 103% |
| First Health-All Plans | $98 - $527 | 103% |
| 6 Degrees Health-All Plans | $103 - $522 | 108% |
| Humana | $176 - $514 | 185% |
| Medica Prime Solutions-All Plans | $176 - $514 | 185% |
| Pacific Source Mcr Adv | $176 - $514 | 185% |
| Amish Old Orders-All Plans | $216 - $412 | 227% |
| Fedmed Network-All Plans | $259 - $522 | 272% |
| Americas Choice-All Plans | $274 - $522 | 288% |
| Three Rivers-All Plans | $274 - $522 | 288% |