Office visit, established patient (20-29 min)
Facility: Susan B Allen Memorial Hospital
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $554
- Cash Discount Price: $88
- vs. Medicare Baseline: 5.82x 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 582% of the Medicare baseline (a markup of 482%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 368% |
| Providrs Care | $757 | 795% |
Consumer Guidance & Cost Commentary
For this office visit at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price of $88.00 is significantly lower than the facility's negotiated rates with UnitedHealthcare ($350) and Providrs Care ($757). While the hospital's cash rate is also lower than the state average of $135.00, it remains higher than the Medicare benchmark of $95.19. This pricing structure highlights a common scenario where commercial insurance contracts can result in much higher out-of-pocket costs than paying cash directly. If you have a high-deductible plan, paying the cash price of $88.00 upfront may be more affordable than your insurance applying its negotiated rate of $350 to $757, especially if you have not yet met your deductible.
To maximize savings, we recommend contacting the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by 20% to 50% for upfront payment. It is also important to verify your specific plan's allowed amount before scheduling, as assuming that being in-network guarantees the lowest price is a common pitfall; in this case, the negotiated rates are substantially higher than the cash option. Finally, if you do receive a bill, always request a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors that can be corrected through a formal audit.