Office visit, established patient (20-29 min)
Facility: The Medical Center of Southeast Texas
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $330
- Cash Discount Price: $537
- vs. Medicare Baseline: 3.47x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 347% of the Medicare baseline (a markup of 247%). 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 |
|---|---|---|
| Community Health Choice | $30 - $32 | 32% |
| Medicaid / KanCare | $38 - $46 | 40% |
| Amerigroup | $41 - $72 | 43% |
| Community Health Choice Uhrip | $41 - $44 | 43% |
| Harbor Hospice | $41 - $44 | 43% |
| Texas Childrens Health Plan | $41 - $46 | 43% |
| Molina Healthcare | $44 - $275 | 46% |
| UnitedHealthcare | $44 - $200 | 46% |
| Beacon Health | $48 - $50 | 50% |
| Superior Healthplan | $50 | 53% |
| Self Pay Emergent | $79 - $82 | 83% |
| League Medical Concepts | $94 | 99% |
| Employer Direct Healthcare | $108 - $154 | 113% |
| Texas Medical Management Partners | $108 - $154 | 113% |
| Selectcare | $131 - $137 | 138% |
| Blue Cross Blue Shield | $216 - $288 | 227% |
| Dept Of Assistive And Rehabilitative Services | $262 - $275 | 275% |
| Aetna | $304 - $363 | 319% |
| Elap Services | $314 - $330 | 330% |
| Iasis Employees | $314 - $330 | 330% |
| Magellan Behavioral Health | $314 - $330 | 330% |
| Wellcare Of Texas | $340 - $357 | 357% |
| Humana | $345 - $363 | 362% |
| Cigna | $366 - $385 | 384% |
| First Health | $366 - $385 | 384% |
| Galaxy Health Network | $366 - $385 | 384% |
| Private Healthcare Systems | $366 - $385 | 384% |
| Texas Municipal League | $366 - $385 | 384% |
| Healthsmart | $393 - $412 | 413% |
| Multiplan | $419 - $440 | 440% |
| Commercial Non-Contracted | $523 - $550 | 549% |
| Heart To Heart Hospice | $523 - $550 | 549% |
| Lifesynch | $523 - $550 | 549% |
| Mhnet | $523 - $550 | 549% |
| Self Pay - Mcd Pending 100 Percent | $523 - $550 | 549% |
| Single Case Agreement | $523 - $550 | 549% |
| Tricare | $523 - $550 | 549% |
| United Behavioral Health | $523 - $550 | 549% |