Office visit, established patient (20-29 min)
Facility: St David's South Austin Medical Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $291
- Cash Discount Price: $582
- vs. Medicare Baseline: 3.06x 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 306% of the Medicare baseline (a markup of 206%). 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 |
|---|---|---|
| Superior Health Plan | $17 - $381 | 18% |
| Amerigroup | $29 | 30% |
| Imperial Insurance | $64 - $426 | 67% |
| Moda | $79 - $527 | 83% |
| United | $83 - $1,008 | 87% |
| Covenant Management Systems | $96 - $645 | 101% |
| Cigna | $97 - $919 | 102% |
| Healthcare Highways | $97 - $672 | 102% |
| Imo Med - Select Network | $100 - $672 | 105% |
| Blue Cross Blue Shield | $107 - $715 | 112% |
| Nomi Health | $107 - $829 | 112% |
| Shared Health | $117 - $784 | 123% |
| Aetna | $118 - $1,237 | 124% |
| Moda Health | $121 - $829 | 127% |
| Evry Health | $123 - $825 | 129% |
| Texas Healthcare Foundation Heb | $124 - $829 | 130% |
| Texas Workforce Commission | $131 - $874 | 138% |
| Curative Administrators | $134 - $896 | 141% |
| Harbor Health Team | $134 - $896 | 141% |
| Averde Health | $151 - $1,008 | 159% |
| Naphcare | $151 - $1,008 | 159% |
| Seven Corners | $151 - $1,008 | 159% |
| Austin Fc | $168 - $1,120 | 176% |
| Comanche County | $168 - $1,120 | 176% |
| Emerging Therapy Solutions | $168 - $1,546 | 176% |
| National Choicecare | $168 - $1,120 | 176% |
| Healthsmart Preferred Care | $184 - $1,793 | 193% |
| Independent Medical Systems | $184 - $1,233 | 193% |
| Physicians Cooperative Of Texas | $184 - $1,233 | 193% |
| Prime Health | $201 - $1,345 | 211% |
| First Health | $211 - $1,611 | 222% |
| Coastal Comp Health Networks | $218 - $1,457 | 229% |
| National Health Care | $218 - $1,457 | 229% |
| Occunet | $234 - $1,569 | 246% |
| Texas Municipal League | $234 - $1,569 | 246% |
| Medcorp Southwest | $251 - $1,681 | 264% |
| Preferred Health Arrangement | $251 - $1,681 | 264% |
| Rockport Healthcare Group | $268 - $2,017 | 282% |
| Bce Emergis Corporation | $302 - $2,017 | 317% |
| Beech Street | $302 - $2,017 | 317% |
| Medical Control Network Solutions | $302 - $2,017 | 317% |
| Multiplan | $302 - $2,017 | 317% |
| UnitedHealthcare | $335 - $2,241 | 352% |
| Oscar | $430 - $480 | 452% |