Office visit, established patient (20-29 min)
Facility: Greeley County Health Services
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $230
- Cash Discount Price: $103
- vs. Medicare Baseline: 2.42x 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 242% of the Medicare baseline (a markup of 142%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $173 | 182% |
| Medicare (plans) | $230 | 242% |
| Veterans Affairs Community Care Network | $230 | 242% |
Consumer Guidance & Cost Commentary
For this office visit at Greeley County Health Services in Tribune, Kansas, the cash price of $103.00 is significantly lower than the facility's negotiated rate of $230.00 for Blue Cross Blue Shield and Medicare plans. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that commercial negotiated rates often include administrative overhead and contract premiums that can inflate the final bill. If you have a high-deductible plan or have not yet met your deductible, paying the cash price upfront may result in immediate savings compared to having insurance process a claim at the higher negotiated rate. It is always advisable to ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the total cost.
The Medicare benchmark for this service is $95.19, which serves as a scientifically validated baseline for the true cost of care delivery. Although the cash price of $103.00 is slightly higher than the Medicare rate, it remains substantially below the commercial negotiated rates of $173.00 to $230.00 depending on the payer. This pricing structure highlights the importance of comparing rates against the Medicare benchmark rather than the hospital's gross chargemaster, which can be inflated to make discounts appear larger than they are. To ensure you are receiving fair pricing, we recommend requesting a detailed, itemized bill that breaks down every CPT code and service rendered, allowing you to verify that no unbundled charges or services not received have been included in the final invoice.