CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Mercy Hospital St Louis
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $116
- Cash Discount Price: $165
- vs. Medicare Baseline: 0.86x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Mercy Hospital St Louis is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.86x the Medicare baseline. Located in 615 New Ballas Road, Saint Louis, MO.
Cash / Self-Pay
$165
Average discount available for prompt cash payment at this facility.
Insurance Median
$116
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$135.6
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $165 (122%)
Insurance Median: $116 (86%)
Cash: $165 (122% of Medicare)
Ins. Median: $116 (86% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $135.6 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 |
|---|---|---|
| Aetna | $14 - $214 | 10% |
| Medicaid / KanCare | $14 - $165 | 10% |
| Medica Contracted [320239] | $32 - $239 | 24% |
| Ambetter / Centene | $33 - $165 | 24% |
| Home State Health Plan Contracted [320187] | $33 - $165 | 24% |
| Novasys Contracted [320285] | $33 - $165 | 24% |
| Aither Health Contracted [320449] | $53 - $304 | 39% |
| Aither Health [20449] | $53 - $304 | 39% |
| Auxiant Contracted [320462] | $53 - $304 | 39% |
| Ebms Contracted [320493] | $53 - $304 | 39% |
| Edison Health Solutions Contracted [320502] | $53 - $304 | 39% |
| Healthlink Contracted [320179] | $53 - $415 | 39% |
| Imagine 360 Contracted [320494] | $53 - $304 | 39% |
| Mercy Benefit Admin Contracted [320251] | $53 - $304 | 39% |
| Mercy Benefit Admin [20251] | $53 - $304 | 39% |
| Reflect Health Contracted [320492] | $53 - $304 | 39% |
| Show-Me Health Administrators Contracted [320483] | $53 - $310 | 39% |
| Yuzu Health Contracted [320521] | $53 - $304 | 39% |
| Cigna | $56 - $464 | 41% |
| Blue Cross Blue Shield | $59 - $2,237 | 44% |
| Health Choices Contracted [320448] | $74 - $366 | 55% |
| Health Choices [20448] | $74 - $366 | 55% |
| Medical Associates Health Contracted [320444] | $74 - $366 | 55% |
| Federal Medical Center Contracted [320127] | $81 - $396 | 60% |
| Insurance System Inc Contracted [320465] | $81 - $396 | 60% |
| Point C Contracted [320238] | $81 - $396 | 60% |
| Tri State Healthcare Coalition Contracted [320379] | $81 - $396 | 60% |
| First Health Contracted [320128] | $87 - $433 | 64% |
| Mercy Mgd Behavioral Health Contracted [320259] | $87 - $427 | 64% |
| Multiplan Contracted [320270] | $87 - $458 | 64% |
| Private Health Care Systems Contracted [320320] | $87 - $427 | 64% |
| American Health Advantage Of Mo Mcr [10473] | $91 | 67% |
| Cherokee Nation Health Serv Contracted [320066] | $91 | 67% |
| Cross Timbers Hospice [20098] | $91 | 67% |
| Dept Of Veteran Affairs Contracted [320106] | $91 | 67% |
| Elara Caring Aspire Hospice Contracted [320433] | $91 | 67% |
| Elara Caring Aspire Hospice [20433] | $91 | 67% |
| Globalhealth Contracted [320145] | $91 | 67% |
| Halo Hcr Inc Hospice Contracted [320432] | $91 | 67% |
| Halo Hcr Inc Hospice [20432] | $91 | 67% |
| Humana | $91 - $94 | 67% |
| Kindful Hospice Contracted [320434] | $91 | 67% |
| Kindful Hospice [20434] | $91 | 67% |
| Medicare (plans) | $91 - $610 | 67% |
| Mercy Hospice Okc [20252] | $91 | 67% |
| Pace Of The Ozarks Contracted [320518] | $91 | 67% |
| Qual Choice Contracted [320325] | $91 | 67% |
| Tricare | $91 | 67% |
| UnitedHealthcare | $91 - $311 | 67% |
| Workers Comp [20426] | $93 - $488 | 69% |
| Provider Partners Health Plans Contracted [320450] | $100 | 74% |
| Healthscope Contracted [320182] | $114 | 84% |
| Centivo Contracted [320505] | $153 | 113% |
| Preferred Health Plan Contracted [320522] | $162 | 119% |
| United Medical Resources Contracted [320454] | $168 - $311 | 124% |
| Hope Trust Contracted [320488] | $208 | 153% |