CMS Price Transparency Data
Office visit, established patient (20-29 min)
Facility: Mercy Hospital Carthage
Billing Code: 99213 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99213
- Insurance Median: $110
- Cash Discount Price: $120
- vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mercy Hospital Carthage is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.16x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$120
Average discount available for prompt cash payment at this facility.
Insurance Median
$110
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: $120 (126%)
Insurance Median: $110 (116%)
Cash: $120 (126% of Medicare)
Ins. Median: $110 (116% 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 | $32 - $110 | 34% |
| Tricare | $35 - $55 | 37% |
| Humana | $38 - $80 | 40% |
| Point C Contracted [320238] | $45 - $181 | 47% |
| Aetna | $51 - $179 | 54% |
| Blue Cross Blue Shield | $51 - $111 | 54% |
| Cherokee Nation Health Serv Contracted [320066] | $51 - $56 | 54% |
| Cigna | $51 - $181 | 54% |
| Cross Timbers Hospice [20098] | $51 - $56 | 54% |
| Dept Of Veteran Affairs Contracted [320106] | $51 - $57 | 54% |
| Elara Caring Aspire Hospice [20433] | $51 - $56 | 54% |
| Globalhealth Contracted [320145] | $51 - $56 | 54% |
| Halo Hcr Inc Hospice Contracted [320432] | $51 - $56 | 54% |
| Halo Hcr Inc Hospice [20432] | $51 - $56 | 54% |
| Indian Health Service Contracted [320198] | $51 - $56 | 54% |
| Kindful Hospice Contracted [320434] | $51 - $56 | 54% |
| Kindful Hospice [20434] | $51 - $56 | 54% |
| Medical Associates Health Contracted [320444] | $51 - $56 | 54% |
| Medicare (plans) | $51 - $63 | 54% |
| Mercy Hospice Okc [20252] | $51 - $56 | 54% |
| Mercy Mgd Behavioral Health Contracted [320259] | $51 - $56 | 54% |
| Pace Of The Ozarks Contracted [320518] | $51 - $56 | 54% |
| Provider Partners Health Plans Contracted [320450] | $51 - $56 | 54% |
| Qual Choice Contracted [320325] | $51 - $56 | 54% |
| UnitedHealthcare | $51 - $175 | 54% |
| Health Systems Inc Contracted [320174] | $55 - $86 | 58% |
| Insurance System Inc Contracted [320465] | $55 - $86 | 58% |
| Centivo Contracted [320505] | $57 - $92 | 60% |
| Administrative Payor Contracted [320005] | $58 - $90 | 61% |
| Healthscope Contracted [320182] | $61 - $105 | 64% |
| Ambetter / Centene | $70 - $110 | 74% |
| Home State Health Plan Contracted [320187] | $70 - $110 | 74% |
| Novasys Contracted [320285] | $70 - $110 | 74% |
| Benefit Management Contracted [320052] | $77 - $175 | 81% |
| Auxiant Contracted [320462] | $83 - $171 | 87% |
| Healthlink Contracted [320179] | $83 - $187 | 87% |
| Preferred Health Plan Contracted [320522] | $83 - $131 | 87% |
| Workers Comp [20426] | $102 - $201 | 107% |
| United Medical Resources Contracted [320454] | $106 - $181 | 111% |
| 90 Degree Benefits Contracted [320436] | $109 - $171 | 115% |
| Aither Health Contracted [320449] | $109 - $171 | 115% |
| Ebms Contracted [320493] | $109 - $171 | 115% |
| Edison Health Solutions Contracted [320502] | $109 - $171 | 115% |
| Imagine 360 Contracted [320494] | $109 - $171 | 115% |
| Mercy Benefit Admin Contracted [320251] | $109 - $181 | 115% |
| Reflect Health Contracted [320492] | $109 - $171 | 115% |
| Show-Me Health Administrators Contracted [320483] | $109 - $171 | 115% |
| Yuzu Health Contracted [320521] | $109 - $171 | 115% |
| Evolutions Health Care Contracted [320124] | $111 - $175 | 117% |
| First Health Contracted [320128] | $111 - $175 | 117% |
| Medica Contracted [320239] | $111 - $174 | 117% |
| Multiplan Contracted [320270] | $111 - $175 | 117% |
| Private Health Care Systems Contracted [320320] | $111 - $175 | 117% |
| American Healthcare Alliance Contracted [320020] | $115 - $181 | 121% |
| Ppo Plus Contracted [320310] | $115 - $181 | 121% |
| Usa Managed Care Org Contracted [320429] | $115 - $181 | 121% |