CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: The Children's Mercy Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $126
Cash Discount Price: $109
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at The Children's Mercy Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.32x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$109

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $109 (115%)

Insurance Median: $126 (132%)

Cash: $109 (115% of Medicare)

Ins. Median: $126 (132% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
UnitedHealthcare	$48 - $196	50%
Healthy Blue	$51 - $94	54%
Medicaid / KanCare	$52 - $131	55%
Healthlink	$62 - $256	65%
Quiktrip	$62 - $189	65%
Blue Cross Blue Shield	$64 - $215	67%
Multiplan	$77 - $221	81%
Aetna	$79 - $198	83%
Wppa Providrs Care	$86 - $189	90%
Health Midwest Comprehensive Care	$89 - $189	93%
Humana	$92 - $194	97%
American Healthcare Alliance	$93 - $247	98%
Orscheln	$93 - $189	98%
Home State Health	$94	99%
Cigna	$95 - $250	100%
Medica	$96 - $170	101%
Nebraska Furniture Mart	$96 - $189	101%
Coventry Health Care Of Kansas	$100 - $215	105%
Mercy Health	$120 - $218	126%
Coxhealth Network	$122 - $215	128%
Wellfit/Centrus	$123 - $189	129%
Centivo	$126 - $189	132%
National Preferred Provider Network	$145 - $262	152%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $109.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The Children's Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.