Office visit, established patient (20-29 min)
Facility: Centura St. Catherine-Dodge City
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $61
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.64x 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 |
|---|---|---|
| Kaiser | $60 | 63% |
| Blue Cross Blue Shield | $60 - $157 | 63% |
| Medicare (plans) | $60 | 63% |
| Kansas Health | $60 | 63% |
| Aetna | $60 | 63% |
| Humana | $60 | 63% |
| Cigna | $60 | 63% |
Consumer Guidance & Cost Commentary
For this office visit code (99213) at Centura St. Catherine-Dodge City in Dodge City, KS, the facility's negotiated rates range from $60 to $157 across seven payers, with a median negotiated rate of $61.00. These rates are significantly lower than the facility's Medicare benchmark of $95.19, indicating a markup that is well below the typical commercial range of 200% to 300% of Medicare. While the data does not provide specific county or state average comparisons for this specific code, the facility's proprietary ownership and integrated-system internal rate for Kaiser suggest that in-network members may benefit from these contracted ceilings, though patients should verify their specific plan's allowed amount before scheduling to ensure they are receiving the best possible price.
Patients should be aware that while insurance often covers the negotiated rate, cash-pay options can sometimes be more cost-effective for those with high-deductible plans if the insurance allowed amount exceeds the cash price. Since the cash and median paid values are not listed in the current data, it is crucial to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront. Additionally, because the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should request a full itemized bill to review every charge and avoid unexpected costs from unbundled codes or services not rendered.