Office visit, established patient (20-29 min)
Facility: Wamego Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $48
- Cash Discount Price: $116
- vs. Medicare Baseline: 0.50x 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 |
|---|---|---|
| UnitedHealthcare | $42 - $46 | 44% |
| Medicaid / KanCare | $44 - $48 | 46% |
| Aetna | $44 - $48 | 46% |
| Tricare | $74 | 78% |
| Providrs Care | $80 | 84% |
| Blue Cross Blue Shield | $175 - $185 | 184% |
Consumer Guidance & Cost Commentary
For this office visit at Wamego Health Center in Wamego, KS, the cash price is $116.00, which is significantly lower than the facility's gross charge of $290.00. While Medicaid and Aetna plans negotiate rates between $44 and $48, and UnitedHealthcare ranges from $42 to $46, these in-network amounts are higher than the cash price. This is a common scenario where paying out-of-pocket can be more cost-effective for patients with high-deductible plans, as the insurance negotiated rate often exceeds the cash price. To maximize savings, patients should ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
When comparing pricing to federal standards, the Medicare benchmark for this service is $95.19. The facility's cash rate of $116.00 is approximately 50% higher than the Medicare amount, which falls within the typical range where commercial rates exceed the true cost of care. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still request an itemized bill to ensure no unbundled charges or services not rendered are included. If you receive a summary bill, you have the right to demand a full line-by-line statement to identify any errors before paying.