CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital Springfield
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $134
- Cash Discount Price: $155
- vs. Medicare Baseline: 1.41x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Springfield is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.41x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$155
Average discount available for prompt cash payment at this facility.
Insurance Median
$134
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: $155 (163%)
Insurance Median: $134 (141%)
Cash: $155 (163% of Medicare)
Ins. Median: $134 (141% 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 | $12 - $3,263 | 13% |
| Benefit Management Contracted [320052] | $35 - $910 | 37% |
| Health Systems Inc Contracted [320174] | $35 - $910 | 37% |
| Insurance System Inc Contracted [320465] | $35 - $910 | 37% |
| Medica Contracted [320239] | $35 - $899 | 37% |
| Medica [20239] | $35 - $899 | 37% |
| Ambetter / Centene | $36 - $3,263 | 38% |
| Home State Health Plan Contracted [320187] | $36 - $3,263 | 38% |
| Novasys Contracted [320285] | $36 - $3,263 | 38% |
| Administrative Payor Contracted [320005] | $40 - $1,138 | 42% |
| Evolutions Health Care Contracted [320124] | $40 - $1,024 | 42% |
| Point C Contracted [320238] | $40 - $1,707 | 42% |
| Point C [20238] | $40 - $1,024 | 42% |
| Aetna | $44 - $1,138 | 46% |
| Medical Destinations Contracted [320242] | $44 - $1,138 | 46% |
| Mercy Benefit Admin Contracted [320251] | $44 - $1,366 | 46% |
| Workers Comp [20426] | $44 - $1,935 | 46% |
| United Medical Resources Contracted [320454] | $46 - $3,803 | 48% |
| First Health Contracted [320128] | $49 - $1,275 | 51% |
| Aither Health Contracted [320449] | $50 - $1,297 | 53% |
| Auxiant Contracted [320462] | $50 - $1,479 | 53% |
| Ebms Contracted [320493] | $50 - $1,297 | 53% |
| Edison Health Solutions Contracted [320502] | $50 - $1,297 | 53% |
| Healthlink Contracted [320179] | $50 - $1,821 | 53% |
| Imagine 360 Contracted [320494] | $50 - $1,297 | 53% |
| Reflect Health Contracted [320492] | $50 - $1,297 | 53% |
| Yuzu Health Contracted [320521] | $50 - $1,297 | 53% |
| 90 Degree Benefits Contracted [320436] | $53 - $1,366 | 56% |
| Federal Medical Center Contracted [320127] | $53 - $1,366 | 56% |
| Show-Me Health Administrators Contracted [320483] | $53 - $1,366 | 56% |
| American Healthcare Alliance Contracted [320020] | $56 | 59% |
| Blue Cross Blue Shield | $60 - $1,739 | 63% |
| Centurion Of Missouri [20459] | $60 | 63% |
| Champva [20065] | $60 | 63% |
| Cherokee Nation Health Serv Contracted [320066] | $60 | 63% |
| Cigna | $60 - $1,753 | 63% |
| Cross Timbers Hospice [20098] | $60 | 63% |
| Dept Of Veteran Affairs Contracted [320106] | $60 | 63% |
| Elara Caring Aspire Hospice [20433] | $60 | 63% |
| Globalhealth Contracted [320145] | $60 | 63% |
| Halo Hcr Inc Hospice Contracted [320432] | $60 | 63% |
| Halo Hcr Inc Hospice [20432] | $60 | 63% |
| Humana | $60 - $1,548 | 63% |
| Indian Health Service Contracted [320198] | $60 | 63% |
| Indian Health Service [20198] | $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% |
| Mercy Rehab Hospital Contracted [320260] | $60 | 63% |
| Pace Of The Ozarks Contracted [320518] | $60 | 63% |
| Qual Choice Contracted [320325] | $60 | 63% |
| Tricare | $60 | 63% |
| UnitedHealthcare | $60 - $5,779 | 63% |
| Provider Partners Health Plans Contracted [320450] | $66 | 69% |
| Multiplan Contracted [320270] | $68 - $1,753 | 71% |
| Private Health Care Systems Contracted [320320] | $68 - $1,753 | 71% |
| Compcare Of The Ozarks Contracted [320437] | $70 - $1,798 | 74% |
| Qual Choice Contracted [320324] | $70 - $1,821 | 74% |
| Municipal Health Plan Contracted [320271] | $71 - $1,844 | 75% |
| Healthscope Contracted [320182] | $75 | 79% |
| Usa Managed Care Org Contracted [320429] | $77 - $2,003 | 81% |
| Ppo Plus Contracted [320310] | $79 - $2,048 | 83% |
| Centivo Contracted [320505] | $101 | 106% |
| Providrs Care Network Contracted [320484] | $115 | 121% |