CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital Joplin
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $153
- Cash Discount Price: $162
- vs. Medicare Baseline: 1.61x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Joplin is $153. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.61x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.
Cash / Self-Pay
$162
Average discount available for prompt cash payment at this facility.
Insurance Median
$153
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: $162 (170%)
Insurance Median: $153 (161%)
Cash: $162 (170% of Medicare)
Ins. Median: $153 (161% 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 |
|---|---|---|
| Medicaid / KanCare | $13 - $2,542 | 14% |
| Ambetter / Centene | $25 - $2,542 | 26% |
| Home State Health Plan Contracted [320187] | $25 - $2,542 | 26% |
| Novasys Contracted [320285] | $25 - $2,542 | 26% |
| Humana | $26 - $304 | 27% |
| Point C Contracted [320238] | $31 - $812 | 33% |
| Medica Contracted [320239] | $32 - $369 | 34% |
| United Medical Resources Contracted [320454] | $35 - $670 | 37% |
| UnitedHealthcare | $35 - $416 | 37% |
| Benefit Management Contracted [320052] | $38 - $436 | 40% |
| Health Systems Inc Contracted [320174] | $38 - $436 | 40% |
| Insurance System Inc Contracted [320465] | $38 - $436 | 40% |
| Administrative Payor Contracted [320005] | $40 - $457 | 42% |
| Mercy Benefit Admin Contracted [320251] | $44 - $609 | 46% |
| Aither Health Contracted [320449] | $50 - $579 | 53% |
| Auxiant Contracted [320462] | $50 - $660 | 53% |
| Ebms Contracted [320493] | $50 - $579 | 53% |
| Edison Health Solutions Contracted [320502] | $50 - $579 | 53% |
| Healthlink Contracted [320179] | $50 - $812 | 53% |
| Imagine 360 Contracted [320494] | $50 - $579 | 53% |
| Reflect Health Contracted [320492] | $50 - $579 | 53% |
| Yuzu Health Contracted [320521] | $50 - $579 | 53% |
| 90 Degree Benefits Contracted [320436] | $53 - $609 | 56% |
| Show-Me Health Administrators Contracted [320483] | $53 - $609 | 56% |
| Aetna | $55 - $629 | 58% |
| Indian Health Service Contracted [320198] | $57 - $660 | 60% |
| Preferred Health Plan Contracted [320522] | $57 - $660 | 60% |
| Blue Cross Blue Shield | $60 - $861 | 63% |
| Champva [20065] | $60 | 63% |
| Cherokee Nation Health Serv Contracted [320066] | $60 | 63% |
| Cigna | $60 - $782 | 63% |
| Cross Timbers Hospice [20098] | $60 | 63% |
| Dept Of Veteran Affairs Contracted [320106] | $60 | 63% |
| Elara Caring Aspire Hospice [20433] | $60 | 63% |
| First Health Contracted [320128] | $60 - $691 | 63% |
| Globalhealth Contracted [320145] | $60 | 63% |
| Halo Hcr Inc Hospice Contracted [320432] | $60 | 63% |
| Halo Hcr Inc Hospice [20432] | $60 | 63% |
| Kindful Hospice Contracted [320434] | $60 | 63% |
| Kindful Hospice [20434] | $60 | 63% |
| Medicare (plans) | $60 - $64 | 63% |
| Mercy Hospice Okc [20252] | $60 | 63% |
| Mercy Mgd Behavioral Health Contracted [320259] | $60 | 63% |
| Pace Of The Ozarks Contracted [320518] | $60 | 63% |
| Provider Partners Health Plans Contracted [320450] | $60 | 63% |
| Qual Choice Contracted [320325] | $60 | 63% |
| Tricare | $60 | 63% |
| American Healthcare Alliance Contracted [320020] | $62 - $710 | 65% |
| Multiplan Contracted [320270] | $68 - $782 | 71% |
| Private Health Care Systems Contracted [320320] | $68 - $782 | 71% |
| Usable Contracted [320409] | $68 - $782 | 71% |
| Point C [20238] | $70 - $812 | 74% |
| Workers Comp [20426] | $70 - $1,015 | 74% |
| Healthscope Contracted [320182] | $75 | 79% |
| Usa Managed Care Org Contracted [320429] | $77 - $893 | 81% |
| Ppo Plus Contracted [320310] | $79 - $914 | 83% |
| Centivo Contracted [320505] | $101 | 106% |
| Providrs Care Network Contracted [320484] | $115 | 121% |
| Health Choice Contracted [320166] | $127 | 133% |