Office visit, established patient (20-29 min)
Facility: Mercy Hospital Southeast
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $220
- Cash Discount Price: $215
- vs. Medicare Baseline: 2.31x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 231% of the Medicare baseline (a markup of 131%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $13 - $194 | 14% |
| Aetna | $20 - $828 | 21% |
| Blue Cross Blue Shield | $42 - $1,228 | 44% |
| First Health Contracted [320128] | $56 - $828 | 59% |
| Health Alliance Contracted [320164] | $57 - $840 | 60% |
| Aither Health Contracted [320449] | $60 - $879 | 63% |
| Cross Timbers Hospice [20098] | $60 | 63% |
| Dept Of Veteran Affairs Contracted [320106] | $60 | 63% |
| Edison Health Solutions Contracted [320502] | $60 - $879 | 63% |
| Elara Caring Aspire Hospice Contracted [320433] | $60 | 63% |
| Elara Caring Aspire Hospice [20433] | $60 | 63% |
| Halo Hcr Inc Hospice Contracted [320432] | $60 | 63% |
| Halo Hcr Inc Hospice [20432] | $60 | 63% |
| Healthlink Contracted [320179] | $60 - $1,009 | 63% |
| Humana | $60 - $1,099 | 63% |
| Kindful Hospice Contracted [320434] | $60 | 63% |
| Kindful Hospice [20434] | $60 | 63% |
| Medicare (plans) | $60 - $64 | 63% |
| Mercy Benefit Admin Contracted [320251] | $60 - $879 | 63% |
| Mercy Benefit Admin [20251] | $60 - $879 | 63% |
| Mercy Hospice Okc [20252] | $60 | 63% |
| Pace Of The Ozarks Contracted [320518] | $60 | 63% |
| Tricare | $60 | 63% |
| UnitedHealthcare | $60 - $146 | 63% |
| Yuzu Health Contracted [320521] | $60 - $879 | 63% |
| American Health Advantage Of Mo Mcr Hmo Contracted [320264] | $62 | 65% |
| Cigna | $62 - $14,290 | 65% |
| Workers Comp [20426] | $66 - $1,034 | 69% |
| Provider Partners Health Plans Contracted [320450] | $69 | 72% |
| Multiplan Contracted [320270] | $70 - $1,034 | 74% |
| Private Health Care Systems Contracted [320320] | $70 - $1,034 | 74% |
| Ambetter / Centene | $79 | 83% |
| Home State Health Plan Contracted [320187] | $79 | 83% |
| Consociate Consolidated Health Contracted [320490] | $84 - $135 | 88% |
| Centivo Contracted [320505] | $101 | 106% |
| Auxiant Contracted [320462] | $104 - $123 | 109% |
| Ebms Contracted [320493] | $104 | 109% |
| Imagine 360 Contracted [320494] | $104 | 109% |
| Preferred Health Plan Contracted [320522] | $107 | 112% |
| Reflect Health Contracted [320492] | $107 | 112% |
| Hope Trust Contracted [320488] | $150 | 158% |