CMS Price Transparency Data
New patient office visit (30-44 min)
Facility: Mercy Hospital Springfield
Billing Code: 99203 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99203
- Insurance Median: $101
- Cash Discount Price: $127
- vs. Medicare Baseline: 0.86x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Mercy Hospital Springfield is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.86x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$127
Average discount available for prompt cash payment at this facility.
Insurance Median
$101
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$117.57
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $127 (108%)
Insurance Median: $101 (86%)
Cash: $127 (108% of Medicare)
Ins. Median: $101 (86% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $117.57 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 | $12 - $3,263 | 10% |
| Benefit Management Contracted [320052] | $43 - $110 | 37% |
| Health Systems Inc Contracted [320174] | $43 - $110 | 37% |
| Insurance System Inc Contracted [320465] | $43 - $110 | 37% |
| Medica Contracted [320239] | $43 - $109 | 37% |
| Medica [20239] | $43 - $109 | 37% |
| Ambetter / Centene | $44 - $3,263 | 37% |
| Home State Health Plan Contracted [320187] | $44 - $3,263 | 37% |
| Novasys Contracted [320285] | $44 - $3,263 | 37% |
| Administrative Payor Contracted [320005] | $49 - $138 | 42% |
| Evolutions Health Care Contracted [320124] | $49 - $124 | 42% |
| Point C Contracted [320238] | $49 - $207 | 42% |
| Point C [20238] | $49 - $124 | 42% |
| Aetna | $54 - $138 | 46% |
| Medical Destinations Contracted [320242] | $54 - $138 | 46% |
| Mercy Benefit Admin Contracted [320251] | $54 - $166 | 46% |
| Workers Comp [20426] | $54 - $235 | 46% |
| American Healthcare Alliance Contracted [320020] | $56 | 48% |
| United Medical Resources Contracted [320454] | $56 - $146 | 48% |
| First Health Contracted [320128] | $60 - $155 | 51% |
| Aither Health Contracted [320449] | $62 - $157 | 53% |
| Auxiant Contracted [320462] | $62 - $179 | 53% |
| Ebms Contracted [320493] | $62 - $157 | 53% |
| Edison Health Solutions Contracted [320502] | $62 - $157 | 53% |
| Healthlink Contracted [320179] | $62 - $221 | 53% |
| Imagine 360 Contracted [320494] | $62 - $157 | 53% |
| Reflect Health Contracted [320492] | $62 - $157 | 53% |
| Yuzu Health Contracted [320521] | $62 - $157 | 53% |
| 90 Degree Benefits Contracted [320436] | $65 - $166 | 55% |
| Federal Medical Center Contracted [320127] | $65 - $166 | 55% |
| Show-Me Health Administrators Contracted [320483] | $65 - $166 | 55% |
| Humana | $73 - $188 | 62% |
| Blue Cross Blue Shield | $75 - $674 | 64% |
| Centurion Of Missouri [20459] | $75 | 64% |
| Champva [20065] | $75 | 64% |
| Cherokee Nation Health Serv Contracted [320066] | $75 | 64% |
| Cigna | $75 - $213 | 64% |
| Cross Timbers Hospice [20098] | $75 | 64% |
| Dept Of Veteran Affairs Contracted [320106] | $75 | 64% |
| Elara Caring Aspire Hospice [20433] | $75 | 64% |
| Globalhealth Contracted [320145] | $75 | 64% |
| Halo Hcr Inc Hospice Contracted [320432] | $75 | 64% |
| Halo Hcr Inc Hospice [20432] | $75 | 64% |
| Indian Health Service Contracted [320198] | $75 | 64% |
| Indian Health Service [20198] | $75 | 64% |
| Kindful Hospice Contracted [320434] | $75 | 64% |
| Kindful Hospice [20434] | $75 | 64% |
| Medicare (plans) | $75 - $79 | 64% |
| Mercy Hospice Okc [20252] | $75 | 64% |
| Mercy Mgd Behavioral Health Contracted [320259] | $75 | 64% |
| Mercy Rehab Hospital Contracted [320260] | $75 | 64% |
| Pace Of The Ozarks Contracted [320518] | $75 | 64% |
| Qual Choice Contracted [320325] | $75 | 64% |
| Tricare | $75 | 64% |
| UnitedHealthcare | $75 - $213 | 64% |
| Provider Partners Health Plans Contracted [320450] | $82 | 70% |
| Multiplan Contracted [320270] | $83 - $213 | 71% |
| Private Health Care Systems Contracted [320320] | $83 - $213 | 71% |
| Compcare Of The Ozarks Contracted [320437] | $85 - $218 | 72% |
| Qual Choice Contracted [320324] | $86 - $221 | 73% |
| Municipal Health Plan Contracted [320271] | $87 - $224 | 74% |
| Healthscope Contracted [320182] | $94 | 80% |
| Usa Managed Care Org Contracted [320429] | $95 - $243 | 81% |
| Ppo Plus Contracted [320310] | $97 - $248 | 83% |
| Centivo Contracted [320505] | $125 | 106% |
| Providrs Care Network Contracted [320484] | $142 | 121% |