CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Mercy Hospital Carthage
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $163
- Cash Discount Price: $148
- vs. Medicare Baseline: 1.20x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Mercy Hospital Carthage is $163. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $148. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.20x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$148
Average discount available for prompt cash payment at this facility.
Insurance Median
$163
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$135.6
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $148 (109%)
Insurance Median: $163 (120%)
Cash: $148 (109% of Medicare)
Ins. Median: $163 (120% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $135.6 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 | $48 - $137 | 35% |
| Tricare | $53 - $69 | 39% |
| Humana | $58 - $113 | 43% |
| Aetna | $63 - $222 | 46% |
| Blue Cross Blue Shield | $63 - $167 | 46% |
| Cherokee Nation Health Serv Contracted [320066] | $63 - $87 | 46% |
| Cigna | $63 - $225 | 46% |
| Cross Timbers Hospice [20098] | $63 - $87 | 46% |
| Dept Of Veteran Affairs Contracted [320106] | $63 - $88 | 46% |
| Elara Caring Aspire Hospice [20433] | $63 - $87 | 46% |
| Globalhealth Contracted [320145] | $63 - $87 | 46% |
| Halo Hcr Inc Hospice Contracted [320432] | $63 - $87 | 46% |
| Halo Hcr Inc Hospice [20432] | $63 - $87 | 46% |
| Indian Health Service Contracted [320198] | $63 - $87 | 46% |
| Kindful Hospice Contracted [320434] | $63 - $87 | 46% |
| Kindful Hospice [20434] | $63 - $87 | 46% |
| Medical Associates Health Contracted [320444] | $63 - $87 | 46% |
| Medicare (plans) | $63 - $93 | 46% |
| Mercy Hospice Okc [20252] | $63 - $87 | 46% |
| Mercy Mgd Behavioral Health Contracted [320259] | $63 - $87 | 46% |
| Pace Of The Ozarks Contracted [320518] | $63 - $87 | 46% |
| Provider Partners Health Plans Contracted [320450] | $63 - $87 | 46% |
| Qual Choice Contracted [320325] | $63 - $87 | 46% |
| UnitedHealthcare | $63 - $218 | 46% |
| Point C Contracted [320238] | $67 - $225 | 49% |
| Health Systems Inc Contracted [320174] | $83 - $108 | 61% |
| Insurance System Inc Contracted [320465] | $83 - $108 | 61% |
| Administrative Payor Contracted [320005] | $86 - $112 | 63% |
| Centivo Contracted [320505] | $88 - $115 | 65% |
| Healthscope Contracted [320182] | $95 - $130 | 70% |
| Ambetter / Centene | $105 - $137 | 77% |
| Home State Health Plan Contracted [320187] | $105 - $137 | 77% |
| Novasys Contracted [320285] | $105 - $137 | 77% |
| Benefit Management Contracted [320052] | $115 - $218 | 85% |
| Auxiant Contracted [320462] | $125 - $212 | 92% |
| Healthlink Contracted [320179] | $125 - $232 | 92% |
| Preferred Health Plan Contracted [320522] | $125 - $162 | 92% |
| Workers Comp [20426] | $154 - $250 | 114% |
| United Medical Resources Contracted [320454] | $159 - $225 | 117% |
| 90 Degree Benefits Contracted [320436] | $163 - $212 | 120% |
| Aither Health Contracted [320449] | $163 - $212 | 120% |
| Ebms Contracted [320493] | $163 - $212 | 120% |
| Edison Health Solutions Contracted [320502] | $163 - $212 | 120% |
| Imagine 360 Contracted [320494] | $163 - $212 | 120% |
| Mercy Benefit Admin Contracted [320251] | $163 - $225 | 120% |
| Reflect Health Contracted [320492] | $163 - $212 | 120% |
| Show-Me Health Administrators Contracted [320483] | $163 - $212 | 120% |
| Yuzu Health Contracted [320521] | $163 - $212 | 120% |
| Medica Contracted [320239] | $166 - $216 | 122% |
| Evolutions Health Care Contracted [320124] | $167 - $218 | 123% |
| First Health Contracted [320128] | $167 - $218 | 123% |
| Multiplan Contracted [320270] | $167 - $218 | 123% |
| Private Health Care Systems Contracted [320320] | $167 - $218 | 123% |
| American Healthcare Alliance Contracted [320020] | $173 - $225 | 128% |
| Ppo Plus Contracted [320310] | $173 - $225 | 128% |
| Usa Managed Care Org Contracted [320429] | $173 - $225 | 128% |