Office visit, established patient (20-29 min)
Facility: Mercy Hospital Columbus
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $158
- Cash Discount Price: $126
- vs. Medicare Baseline: 1.66x 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 | $48 - $141 | 50% |
| Medicare (plans) | $63 - $146 | 66% |
| Humana | $80 - $184 | 84% |
| Health Systems Inc Contracted [320174] | $83 | 87% |
| Insurance System Inc Contracted [320465] | $83 | 87% |
| Administrative Payor Contracted [320005] | $87 | 91% |
| Centurion Of Missouri [20459] | $141 | 148% |
| Elara Caring Aspire Hospice [20433] | $141 | 148% |
| Halo Hcr Inc Hospice Contracted [320432] | $141 | 148% |
| Cherokee Nation Health Serv Contracted [320066] | $141 | 148% |
| Kindful Hospice Contracted [320434] | $141 | 148% |
| Aetna | $141 - $175 | 148% |
| Novasys Contracted [320285] | $141 | 148% |
| Halo Hcr Inc Hospice [20432] | $141 | 148% |
| Cross Timbers Hospice [20098] | $141 | 148% |
| Globalhealth Contracted [320145] | $141 | 148% |
| Provider Partners Health Plans Contracted [320450] | $141 | 148% |
| Mercy Mgd Behavioral Health Contracted [320259] | $141 | 148% |
| Qual Choice Contracted [320325] | $141 | 148% |
| Pace Of The Ozarks Contracted [320518] | $141 | 148% |
| Cigna | $141 | 148% |
| Blue Cross Blue Shield | $141 - $174 | 148% |
| Kindful Hospice [20434] | $141 | 148% |
| Ambetter / Centene | $141 | 148% |
| Home State Health Plan Contracted [320187] | $141 | 148% |
| Indian Health Service Contracted [320198] | $141 | 148% |
| Medical Associates Health Contracted [320444] | $141 | 148% |
| UnitedHealthcare | $141 - $161 | 148% |
| Dept Of Veteran Affairs Contracted [320106] | $141 | 148% |
| Tricare | $141 | 148% |
| Mercy Hospice Okc [20252] | $141 | 148% |
| Healthscope Contracted [320182] | $150 | 158% |
| Workers Comp [20426] | $155 - $165 | 163% |
| United Medical Resources Contracted [320454] | $161 - $184 | 169% |
| Medica Contracted [320239] | $174 | 183% |
| American Healthcare Alliance Contracted [320020] | $175 | 184% |
| Usa Managed Care Org Contracted [320429] | $175 | 184% |
| Federal Medical Center Contracted [320127] | $175 | 184% |
| Healthlink Contracted [320179] | $175 - $184 | 184% |
| Preferred Health Plan Contracted [320522] | $175 | 184% |
| Mercy Benefit Admin Contracted [320251] | $175 - $184 | 184% |
| First Health Contracted [320128] | $175 | 184% |
| Aither Health Contracted [320449] | $184 | 193% |
| Ebms Contracted [320493] | $184 | 193% |
| Show-Me Health Administrators Contracted [320483] | $184 | 193% |
| 90 Degree Benefits Contracted [320436] | $184 | 193% |
| Reflect Health Contracted [320492] | $184 | 193% |
| Edison Health Solutions Contracted [320502] | $184 | 193% |
| Auxiant Contracted [320462] | $184 | 193% |
| Imagine 360 Contracted [320494] | $184 | 193% |
| Benefit Management Contracted [320052] | $184 | 193% |
| Ppo Plus Contracted [320310] | $184 | 193% |
| Point C Contracted [320238] | $184 | 193% |
| Private Health Care Systems Contracted [320320] | $184 | 193% |
| Yuzu Health Contracted [320521] | $184 | 193% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the median cash price for this office visit is $126, which is significantly lower than the facility's gross charge of $194. Because cash rates are often lower than what insurance companies negotiate, patients with high-deductible plans or those who have met their deductible may save money by paying out-of-pocket, provided they confirm the facility offers a "self-pay" or "prompt-pay" discount before scheduling. It is important to note that while the cash rate is attractive, some insurance plans might still result in a lower out-of-pocket cost if the negotiated rate combined with the patient's coinsurance or deductible is less than the full cash price.
Regarding broader pricing context, the facility's median negotiated rate is $158, which is higher than the cash price but lower than the gross charge of $194. The Medicare allowed amount for this service is $95.19, which serves as a key benchmark; commercial negotiated rates at this facility average approximately 1.7 times the Medicare rate. This facility is a Critical Access Hospital in Kansas, and the data reflects 56 unique payers, with negotiated rates ranging from a low of $48 to a high of $184 depending on the specific insurance plan.