CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital Aurora
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $269
- Cash Discount Price: $345
- vs. Medicare Baseline: 2.83x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Aurora is $269. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $345. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.83x the Medicare baseline. Located in 500 Porter Avenue, Aurora, MO.
Cash / Self-Pay
$345
Average discount available for prompt cash payment at this facility.
Insurance Median
$269
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: $345 (362%)
Insurance Median: $269 (283%)
Cash: $345 (362% of Medicare)
Ins. Median: $269 (283% 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 283% of the Medicare baseline (a markup of 183%). 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.
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 - $685 | 14% |
| Blue Cross Blue Shield | $46 - $1,352 | 48% |
| Medicare (plans) | $46 - $400 | 48% |
| UnitedHealthcare | $46 - $1,284 | 48% |
| Dept Of Veteran Affairs Contracted [320106] | $47 - $393 | 49% |
| Tricare | $47 - $393 | 49% |
| Aetna | $56 - $1,203 | 59% |
| Cherokee Nation Health Serv Contracted [320066] | $56 - $385 | 59% |
| Cigna | $56 - $1,149 | 59% |
| Cross Timbers Hospice [20098] | $56 - $385 | 59% |
| Elara Caring Aspire Hospice [20433] | $56 - $385 | 59% |
| Globalhealth Contracted [320145] | $56 - $385 | 59% |
| Halo Hcr Inc Hospice Contracted [320432] | $56 - $385 | 59% |
| Halo Hcr Inc Hospice [20432] | $56 - $385 | 59% |
| Healthscope Contracted [320182] | $56 - $498 | 59% |
| Humana | $56 - $1,149 | 59% |
| Indian Health Service Contracted [320198] | $56 - $385 | 59% |
| Kindful Hospice Contracted [320434] | $56 - $385 | 59% |
| Kindful Hospice [20434] | $56 - $385 | 59% |
| Medical Associates Health Contracted [320444] | $56 - $385 | 59% |
| Mercy Hospice Okc [20252] | $56 - $385 | 59% |
| Mercy Mgd Behavioral Health Contracted [320259] | $56 - $385 | 59% |
| Pace Of The Ozarks Contracted [320518] | $56 - $385 | 59% |
| Provider Partners Health Plans Contracted [320450] | $56 - $385 | 59% |
| Qual Choice Contracted [320325] | $56 - $385 | 59% |
| Centivo Contracted [320505] | $64 - $541 | 67% |
| Administrative Payor Contracted [320005] | $72 - $608 | 76% |
| Ambetter / Centene | $81 - $685 | 85% |
| Home State Health Plan Contracted [320187] | $81 - $685 | 85% |
| Novasys Contracted [320285] | $81 - $685 | 85% |
| Healthlink Contracted [320179] | $104 - $1,217 | 109% |
| Preferred Health Plan Contracted [320522] | $104 - $879 | 109% |
| Health Systems Inc Contracted [320174] | $128 - $1,082 | 134% |
| Insurance System Inc Contracted [320465] | $128 - $1,082 | 134% |
| Point C Contracted [320238] | $128 - $1,149 | 134% |
| Point C [20238] | $128 - $1,082 | 134% |
| Workers Comp [20426] | $128 - $1,149 | 134% |
| Medica Contracted [320239] | $135 - $1,144 | 142% |
| 90 Degree Benefits Contracted [320436] | $136 - $1,149 | 143% |
| Aither Health Contracted [320449] | $136 - $1,149 | 143% |
| American Healthcare Alliance Contracted [320020] | $136 - $1,149 | 143% |
| Auxiant Contracted [320462] | $136 - $1,149 | 143% |
| Benefit Management Contracted [320052] | $136 - $1,149 | 143% |
| Ebms Contracted [320493] | $136 - $1,149 | 143% |
| Edison Health Solutions Contracted [320502] | $136 - $1,149 | 143% |
| Evolutions Health Care Contracted [320124] | $136 - $1,149 | 143% |
| First Health Contracted [320128] | $136 - $1,149 | 143% |
| Imagine 360 Contracted [320494] | $136 - $1,149 | 143% |
| Mercy Benefit Admin Contracted [320251] | $136 - $1,149 | 143% |
| Reflect Health Contracted [320492] | $136 - $1,149 | 143% |
| Show-Me Health Administrators Contracted [320483] | $136 - $1,149 | 143% |
| United Medical Resources Contracted [320454] | $136 - $1,190 | 143% |
| Yuzu Health Contracted [320521] | $136 - $1,149 | 143% |
| Usa Managed Care Org Contracted [320429] | $141 - $1,190 | 148% |
| Multiplan Contracted [320270] | $152 - $1,284 | 160% |
| Private Health Care Systems Contracted [320320] | $152 - $1,284 | 160% |