CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital Waldron
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $102
- Cash Discount Price: $167
- vs. Medicare Baseline: 1.07x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Waldron is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.07x the Medicare baseline. Located in 1341 West Sixth Street, Waldron, AR.
Cash / Self-Pay
$167
Average discount available for prompt cash payment at this facility.
Insurance Median
$102
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$95.19
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $95.19 (100%)
Cash / Self-Pay: $167 (175%)
Insurance Median: $102 (107%)
Cash: $167 (175% of Medicare)
Ins. Median: $102 (107% of 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.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $69 | 72% |
| Aetna | $71 - $167 | 75% |
| American Health Advantage Of Mo Mcr [20264] | $71 | 75% |
| Blue Cross Blue Shield | $71 - $102 | 75% |
| Cherokee Nation Health Serv Contracted [320066] | $71 | 75% |
| Cross Timbers Hospice [20098] | $71 | 75% |
| Dept Of Veteran Affairs Contracted [320106] | $71 | 75% |
| Elara Caring Aspire Hospice Contracted [320433] | $71 | 75% |
| Elara Caring Aspire Hospice [20433] | $71 | 75% |
| Globalhealth Contracted [320145] | $71 | 75% |
| Halo Hcr Inc Hospice Contracted [320432] | $71 | 75% |
| Halo Hcr Inc Hospice [20432] | $71 | 75% |
| Humana | $71 - $218 | 75% |
| Independent Health [20197] | $71 | 75% |
| Indian Health Service Contracted [320198] | $71 | 75% |
| Indian Health Service [20198] | $71 | 75% |
| Jordan Valley Senior Care Pace [20515] | $71 | 75% |
| Kindful Hospice Contracted [320434] | $71 | 75% |
| Kindful Hospice [20434] | $71 | 75% |
| Medical Associates Health [20444] | $71 | 75% |
| Medicare (plans) | $71 - $74 | 75% |
| Mercy Hospice Okc [20252] | $71 | 75% |
| Pace Of The Ozarks [20518] | $71 | 75% |
| Provider Partners Health Plans Contracted [320450] | $71 | 75% |
| Qual Choice Contracted [320325] | $71 | 75% |
| Spina Bifida Hlthcare Benefit [20506] | $71 | 75% |
| UnitedHealthcare | $71 - $154 | 75% |
| Valir Pace [20503] | $71 | 75% |
| Cigna | $74 - $218 | 78% |
| Medicaid / KanCare | $80 - $100 | 84% |
| Ambetter / Centene | $100 | 105% |
| Home State Health Plan Contracted [320187] | $100 | 105% |
| Novasys Contracted [320285] | $100 - $562 | 105% |
| Usable Contracted [320409] | $102 | 107% |
| Mercy Interfacility [20513] | $114 | 120% |
| Auxiant Contracted [320462] | $154 - $231 | 162% |
| Mercy Benefit Admin Contracted [320251] | $154 - $231 | 162% |
| Qual Choice Contracted [320324] | $154 | 162% |
| United Medical Resources Contracted [320454] | $154 | 162% |
| Workers Comp [20426] | $167 | 175% |
| 90 Degree Benefits Contracted [320436] | $218 | 229% |
| Aither Health Contracted [320449] | $218 | 229% |
| Ebms Contracted [320493] | $218 | 229% |
| Edison Health Solutions Contracted [320502] | $218 | 229% |
| Healthlink Contracted [320179] | $218 - $231 | 229% |
| Imagine 360 Contracted [320494] | $218 | 229% |
| Multiplan Contracted [320270] | $218 | 229% |
| Multiplan [20270] | $218 | 229% |
| Municipal Health Plan Contracted [320271] | $218 | 229% |
| Reflect Health Contracted [320492] | $218 | 229% |
| Show-Me Health Administrators Contracted [320483] | $218 | 229% |
| Federal Medical Center Contracted [320127] | $231 | 243% |
| Healthscope Contracted [320182] | $231 | 243% |
| Insurance System Inc Contracted [320465] | $231 | 243% |
| Personify Health Contracted [320051] | $231 | 243% |
| Point C Contracted [320238] | $231 | 243% |
| Preferred Health Plan Contracted [320522] | $231 | 243% |
| Tri State Healthcare Coalition Contracted [320379] | $231 | 243% |