Office visit, established patient (20-29 min)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $144
- Cash Discount Price: $127
- vs. Medicare Baseline: 1.51x 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 |
|---|---|---|
| Medicaid / KanCare | $31 - $103 | 33% |
| Medica Contracted [320239] | $45 - $90 | 47% |
| Medicare (plans) | $59 - $60 | 62% |
| Blue Cross Blue Shield | $59 - $161 | 62% |
| Aetna | $59 - $210 | 62% |
| Cross Timbers Hospice [20098] | $59 | 62% |
| Elara Caring Aspire Hospice [20433] | $59 | 62% |
| Halo Hcr Inc Hospice Contracted [320432] | $59 | 62% |
| Kindful Hospice [20434] | $59 | 62% |
| Pace Of The Ozarks Contracted [320518] | $59 | 62% |
| Dept Of Veteran Affairs Contracted [320106] | $59 | 62% |
| Humana | $59 - $80 | 62% |
| Mercy Hospice Okc [20252] | $59 | 62% |
| Halo Hcr Inc Hospice [20432] | $59 | 62% |
| Kindful Hospice Contracted [320434] | $59 | 62% |
| Tricare | $60 | 63% |
| UnitedHealthcare | $62 - $166 | 65% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $62 | 65% |
| United Medical Resources Contracted [320454] | $83 - $166 | 87% |
| Cigna | $85 - $190 | 89% |
| Auxiant Contracted [320462] | $98 - $198 | 103% |
| Edison Health Solutions Contracted [320502] | $98 - $198 | 103% |
| Ebms Contracted [320493] | $98 - $198 | 103% |
| Mercy Benefit Admin Contracted [320251] | $98 - $198 | 103% |
| Reflect Health Contracted [320492] | $98 - $198 | 103% |
| Healthlink Contracted [320179] | $98 - $198 | 103% |
| Workers Comp [20426] | $98 - $198 | 103% |
| Aither Health Contracted [320449] | $98 - $198 | 103% |
| American Healthcare Alliance Contracted [320020] | $98 - $198 | 103% |
| Imagine 360 Contracted [320494] | $98 - $198 | 103% |
| Yuzu Health Contracted [320521] | $98 - $198 | 103% |
| Home State Health Plan Contracted [320187] | $103 | 108% |
| Ambetter / Centene | $103 | 108% |
| First Health Contracted [320128] | $105 - $210 | 110% |
| Providrs Care Network Contracted [320484] | $115 | 121% |
| Health Choice Contracted [320166] | $140 | 147% |
Consumer Guidance & Cost Commentary
For CPT code 99213, an office visit for an established patient lasting 20 to 29 minutes, Mercy Hospital Pittsburg, Inc. lists a cash median price of $127.00, which is notably higher than the state average of $106.00. While the facility's cash rate exceeds the median paid amount, patients with high-deductible plans may find paying cash directly more cost-effective if their insurance negotiated rates exceed this figure. It is important to note that many commercial payers, such as Aetna and UnitedHealthcare, have negotiated rates ranging from $59 to over $198, which can be significantly higher than the cash price. To potentially lower costs, patients should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which often reduce the final bill by 20% to 50% when paid in full upfront.
When reviewing the itemized bill, consumers should request a detailed, line-by-line statement rather than accepting a summary invoice that obscures individual charges. This audit helps identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies. For pricing context, the facility's Medicare benchmark rate is $95.19, and the commercial negotiated average is $144.00, which aligns with the typical range of 120% to 150% of Medicare considered fair. If a patient receives care from an out-of-network provider at this facility, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises